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1.
Eur Spine J ; 32(4): 1140-1145, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36847910

RESUMO

PURPOSE: Preoperative curve assessment is important in adolescent idiopathic scoliosis (AIS). Our objective is to clarify the role of side-bending radiographs (SBR) and fulcrum-bending radiographs (FBR) in predicting postoperative Cobb angle in nonstructural and structural curves. METHODS: Twenty-five consecutive patients with AIS who underwent correction surgery were included. The Cobb angles of structural and nonstructural curves were determined. Cobb angles were measured based on pre- and postoperative standing anteroposterior radiographs of the whole spine. The Cobb angles of SBR and FBR were measured preoperatively. The difference between the Cobb angle at each bending and the preoperative Cobb angle was defined as the predicted correction angle, whereas the difference between the preoperative Cobb angle and postoperative Cobb angle was defined as the surgical correction angle. The correction index was calculated by dividing the surgical correction angle by the predicted correction angle. The difference between the predicted correction angle and surgical correction angle was defined as the prediction error. We compared SBR and FBR for both structural and nonstructural curves in these terms. RESULTS: For both curves, the predicted correction angle of FBR was significantly higher than that of SBR, and the correction index of FBR was significantly lower than that of SBR. Patients with a correction index close to 1 and small prediction error had undergone FBR in the structural curve and SBR in the nonstructural curve. CONCLUSION: FBR is predictive of postoperative correction angle of the structural curve, whereas SBR is predictive of postoperative correction angle of the nonstructural curve.


Assuntos
Cifose , Escoliose , Fusão Vertebral , Humanos , Adolescente , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Vértebras Torácicas/cirurgia , Estudos Prospectivos , Radiografia
2.
J Ultrasound Med ; 42(1): 239-246, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35420732

RESUMO

Cervical disc degeneration commonly results in referred neck pain, which is traditionally diagnosed via fluoroscopy-guided provocative discography. Herein, we discuss three cases of neck and shoulder pain treated with cervical intradiscal injections administered under ultrasound (US) guidance. The most painful intervertebral disc was identified using the sonopalpation technique, which involved palpation while visualizing anatomical structures using US. Injectant spread within the intervertebral disc was validated using superb microvascular imaging rather than fluoroscopy. Symptoms significantly improved following blocks at the identified sites, suggesting that US can be used to guide cervical intradiscal injections even in the examination room.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Disco Intervertebral , Humanos , Disco Intervertebral/diagnóstico por imagem , Fluoroscopia , Ultrassonografia de Intervenção
3.
Br J Neurosurg ; 37(4): 750-754, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31122078

RESUMO

A retro-odontoid pseudotumor (ROP) is commonly associated with atlantoaxial instability (AAI) or rheumatoid arthritis (RA). However, we describe a patient with ROP in the absence of AAI or RA. An 81-year-old man who did not have a history of trauma to the head and neck admitted with neck pain, right upper extremity numbness, lower limb weakness, and walking disturbance. He had a history of C2 dome and C3-7 laminoplasty 10 years ago. Magnetic resonance imaging revealed a retro-odontoid mass with cervical cord compression. Dynamic radiography did not show signs of AAI. He underwent C1 laminectomy without fixation for the ROP. We speculated that the load on C1 and C2 increased because of the progression of kyphosis from C2 to C7 with increases in range of motion, which in turn caused change in the biomechanics of the cervical spine, leading to recurrent partial tear and degradation of the transverse ligament that induced formation of the ROP. Spinal surgeons should keep this complication in mind and inform patients about this potential postoperative complication.


Assuntos
Artrite Reumatoide , Instabilidade Articular , Cifose , Laminoplastia , Processo Odontoide , Masculino , Humanos , Idoso de 80 Anos ou mais , Processo Odontoide/diagnóstico por imagem , Processo Odontoide/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Vértebras Cervicais/patologia , Imageamento por Ressonância Magnética , Cifose/cirurgia , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Artrite Reumatoide/complicações , Artrite Reumatoide/cirurgia , Artrite Reumatoide/patologia
4.
J Ultrasound Med ; 41(7): 1825-1835, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34676569

RESUMO

Sonography is conventionally used to diagnose fractures by identifying cortical discontinuity in the bone. However, its usefulness for diagnosing lumbar transverse process fractures (LTPFs) remains unknown. In this series, we describe static and stress sonography findings during manual application of compression stress on the lateral lumbar vertebrae in 17 patients with LTPFs. Features of LTPFs on static sonography included cortical discontinuity (89.3%), hematoma (71.4%), step-off deformity (67.9%), and focal reverberation echo (78.6%). All LTPFs were confirmed on stress sonography. Thus, stress sonography should be considered for the detection of LTPFs when there is at least one static sonographic fracture sign.


Assuntos
Fraturas Ósseas , Vértebras Lombares , Hematoma , Humanos , Vértebras Lombares/diagnóstico por imagem , Ultrassonografia
5.
J Clin Monit Comput ; 36(1): 259-270, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-33420971

RESUMO

Tetanic stimulation of the peripheral nerve, immediately prior to conducting transcranial electrical stimulation motor evoked potential (TES-MEP), increases MEP amplitudes in both innervated and uninnervated muscles by the stimulated peripheral nerve; this is known as the remote augmentation of MEPs. Nevertheless, the mechanisms underlying the remote augmentation of MEPs remain unclear. Although one hypothesis was that remote augmentation of MEPs results from increased motoneuronal excitability at the spinal cord level, the effect of spinal anterior horn cells has not yet been investigated. We aimed to investigate the effect of tetanic stimulation of the peripheral nerve on spinal cord anterior horn cells by analyzing the F-wave. We included 34 patients who underwent elective spinal surgeries and compared the changes in F-waves and TES-MEPs pre- and post-tetanic stimulation of the median nerve. F-wave analyses were recorded by stimulating the median and tibial nerves. TES-MEPs and F-wave analyses were compared between baseline and post-tetanic stimulation time periods using Wilcoxon signed-rank tests. A significant augmentation of MEPs, independent of the level corresponding to the median nerve, was demonstrated. Furthermore, F-wave persistence was significantly increased not only in the median nerve but also in the tibial nerve after tetanic stimulation of the median nerve. The increased F-wave persistence indicates an increase of re-excited motor units in spinal anterior horn cells. These results confirm the hypothesis that tetanic stimulation of the peripheral nerve may cause remote augmentation of MEPs, primarily by increasing the excitability of the anterior horn cells.


Assuntos
Potencial Evocado Motor , Estimulação Transcraniana por Corrente Contínua , Células do Corno Anterior , Estimulação Elétrica/métodos , Potencial Evocado Motor/fisiologia , Humanos , Nervos Periféricos/fisiologia , Nervo Tibial/fisiologia
6.
BMC Musculoskelet Disord ; 22(1): 22, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407352

RESUMO

BACKGROUND: An important complication of pyogenic spondylitis is aneurysms in the adjacent arteries. There are reports of abdominal aortic or iliac aneurysms, but there are few reports describing infected aneurysms of the vertebral artery. Furthermore, there are no reports describing infected aneurysms of the vertebral arteries following cervical pyogenic spondylitis. We report a rare case of an infected aneurysm of the vertebral artery as a complication of cervical pyogenic spondylitis, which was successfully treated by endovascular treatment. CASE PRESENTATION: Cervical magnetic resonance imaging (MRI) of a 59-year-old man who complained of severe neck pain showed pyogenic spondylitis. Although he was treated extensively by antibiotic therapy, his neck pain did not improve. Follow-up MRI showed the presence of a cyst, which was initially considered an abscess, and therefore, treatment initially included guided tapping and suction under ultrasonography. However, under ultrasonographic examination an aneurysm was detected. The contrast-enhanced computed tomography (CT) scan showed an aneurysm of the vertebral artery. Following endovascular treatment (parent artery occlusion: PAO), the patient's neck pain disappeared completely. CONCLUSION: Although there are several reports of infected aneurysms of the vertebral arteries, this is the first report describing an infected aneurysm of the vertebral artery as a result of cervical pyogenic spondylitis. Whenever a paraspinal cyst exist at the site of infection, we recommend that clinicians use not only X-ray, conventional CT, and MRI to examine the cyst, but ultrasonography and contrast-enhanced CT as well because of the possibility of an aneurysms in neighboring blood vessels. It is necessary to evaluate the morphology of the aneurysm to determine the treatment required.


Assuntos
Aneurisma Infectado , Espondilite , Espondilose , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/etiologia , Aneurisma Infectado/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Espondilite/diagnóstico por imagem , Espondilite/terapia , Artéria Vertebral/diagnóstico por imagem
7.
J Orthop Sci ; 25(5): 763-769, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31771804

RESUMO

BACKGROUND: Magnetic resonance imaging (MRI) is the most helpful for determining the differential diagnosis between metastatic and osteoporotic vertebral fractures; especially whole spine MRI is effective if patients have multiple spinal metastases. However, it is time-consuming to obtain all planes for all metastatic vertebrae. If we can differentiate these metastatic and osteoporotic vertebral fractures based on only one section and signal intensity, it would save time and be effective for patients with pain. This study investigated the usefulness of sagittal T1-weighted MRI findings in differentiating metastatic and osteoporotic vertebral fractures. METHODS: We retrospectively reviewed patients diagnosed with metastatic or osteoporotic vertebral fractures. Findings characteristic of metastatic fractures were considered: (a) pedicle or posterior element involvement; (b) convex posterior border of the vertebral body; (c) epidural infiltration; and (d) diffuse homogeneous low signal intensity; findings characteristic of osteoporotic compression fractures were also considered: (e) low-signal-intensity band and (f) posterior retropulsion. Chi-square test or Fisher's exact probability test was used to investigate the usefulness of each MRI finding. Intra- and inter-observer reliability analysis was performed. RESULTS: This study comprised 43 patients with metastases (45 vertebrae) and 118 patients with osteoporotic fractures (156 vertebrae). All findings showed significant difference with each fracture (p-value: <0.01 to 0.03). Although each MRI finding exhibited high intra- and inter-observer reliability (κ: 0.66 to 1.00), finding (c) exhibited low reliability. Finding (a) showed high sensitivity (88.9%) and usefulness for screening, and findings (b), (d), (e), and (f) showed high specificity (90.4%-100%) and usefulness for definitive diagnosis. CONCLUSIONS: Characteristic findings with sagittal T1-weighted MRI were useful in the differential diagnosis of metastatic and osteoporotic vertebral fractures. To prevent overlooking metastatic fractures with sagittal T1-weighted MRI, findings of the pedicle or posterior element involvement should be focused on because of its reliability and sensitivity.


Assuntos
Fraturas por Osteoporose/diagnóstico por imagem , Fraturas da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
8.
Mod Rheumatol ; 30(3): 580-585, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31116048

RESUMO

Objectives: To clarify the correlation between locomotive syndrome (LS) stages and the loco-check or health-related quality of life (HRQoL) and whether the loco-check can predict HRQoL and LS stages.Methods: Overall, 298 subjects (106 men, 192 women) were evaluated for LS and HRQoL using EuroQoL-5 dimensions (EQ-5D) and the EuroQoL-visual analog scale (EQ-VAS). The correlation between LS stages and HRQoL using EQ-5D and EQ-5D-VAS scores and the number of affirmative answers on the loco-check were evaluated.Results: The numbers of non-LS, Stage 1 LS, and Stage 2 LS subjects were 143, 130, and 25, respectively. EQ-5D and EQ-5D-VAS scores decreased from non-LS to Stage 2 LS. EQ-5D and EQ-5D-VAS scores in LS Stage 2 subjects were significantly lower. The number of affirmative answers on the loco-check increased from non-LS to Stage 2. Two affirmative answers on the loco-check was the cut-off to detect Stage 2 LS. The number of affirmative answers on the loco-check was significantly negatively correlated with HRQoL in elderly subjects.Conclusion: The number of affirmative answers on the loco-check positively correlated with LS stages and negatively correlated with HRQoL. The loco-check might help to predict LS stage and HRQoL, especially in elderly people aged over 65 years.


Assuntos
Locomoção , Qualidade de Vida , Inquéritos e Questionários , Idoso , Estudos Transversais , Progressão da Doença , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade
9.
Opt Express ; 27(10): 15007-15017, 2019 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-31163940

RESUMO

We demonstrated a novel slow-light Si-wire waveguide combined with metamaterials, which can be easily integrated with other Si photonics devices. The slow-light effect can be produced simply by placing metamaterials at an appropriate position on a Si-wire waveguide. It was confirmed that the large group index of more than 40 could be obtained because of a steep and discontinuous change of dispersion relation near the resonance frequency of metamaterials.

10.
J Orthop Sci ; 24(4): 715-719, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30591398

RESUMO

BACKGROUND: Locomotive syndrome (LS) is a condition of decreased mobility caused by disorders of the locomotive organs. Lumbar spinal stenosis (LSS) is an LS disorder. The loco-check is a simple questionnaire comprising seven questions that can detect LS. The differences between the health-related quality of life (HRQoL) of elderly persons without LSS and those with LSS remain unclear. The primary aim of this study was to clarify these differences using the European quality of life (EuroQoL) scale. The secondary aim was to clarify the differences between the groups based on loco-check questionnaire responses. METHODS: We recruited patients aged ≥65 years. Our age- and sex-matched case/control cohorts included 28 elderly patients with LSS and 28 without LSS. The study participants were evaluated by the number of "yes" answers on the loco-check, the HRQoL using EuroQoL-5 dimension (EQ-5D) utility values, and the EuroQoL-visual analog scale (EQ-VAS). We compared differences between patients with and without LSS regarding HRQoL using EQ-5D utility values, EQ-VAS scores, the number of "yes" answers on the loco-check, and details of the loco-check. RESULTS: Patients with LSS had significantly lower EQ-5D utility values (p < 0.01) and more "yes" answers on the loco-check (p < 0.01) than those without LSS. There were no significant differences in EQ-VAS scores between groups (p = 0.09). There were statistically significant differences between groups in all questions except two: You often trip up or slip around the house and You can't make it across the road before the light turns red. CONCLUSIONS: Elderly patients with LSS had lower EQ-5D utility values and more "yes" answers on the loco-check than elderly persons without LSS. Our results may clarify differentiating features of elderly patients with and without LSS.


Assuntos
Avaliação Geriátrica , Nível de Saúde , Locomoção/fisiologia , Vértebras Lombares , Qualidade de Vida , Estenose Espinal/fisiopatologia , Atividades Cotidianas , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Masculino , Estenose Espinal/complicações , Estenose Espinal/prevenção & controle , Inquéritos e Questionários , Síndrome
11.
J Orthop Sci ; 23(3): 578-584, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29478622

RESUMO

PURPOSE: To evaluate whether osteogenic matrix cell sheets can supply osteogenesis to dead bone. METHODS: Femur bone fragments (5 mm in length) were obtained from Fisher 344 rats and irradiated by a single exposure of 60 Gy to produce bones that were no longer viable. Osteogenic matrix cell sheets were created from rat bone marrow-derived stromal cells (BMSCs). After wrapping the dead bone with an osteogenic matrix cell sheet, it was subcutaneously transplanted into the back of a rat and harvested after 4 weeks. Bone formation around the dead bone was evaluated by X-ray imaging and histology. Alkaline phosphatase (ALP) and osteocalcin (OC) mRNA expression levels were measured to confirm osteogenesis of the transplanted bone. The contribution of donor cells to bone formation was assessed using the Sry gene and PKH26. RESULTS: After the cell sheet was transplanted together with dead bone, X-ray images showed abundant calcification around the dead bone. In contrast, no newly formed bone was seen in samples that were transplanted without the cell sheet. Histological sections also showed newly formed bone around dead bone in samples transplanted with the cell sheet, whereas many empty lacunae and no newly formed bone were observed in samples transplanted without the cell sheet. ALP and OC mRNA expression levels were significantly higher in dead bones transplanted with cell sheets than in those without a cell sheet (P < 0.01). Sry gene expression and cells derived from cell sheets labeled with PKH26 were detected in samples transplanted with a cell sheet, indicating survival of donor cells after transplantation. CONCLUSION: Our study indicates that osteogenic matrix cell sheet transplantation can supply osteogenesis to dead bone.


Assuntos
Matriz Óssea/transplante , Fêmur , Transplante de Células-Tronco Mesenquimais/métodos , Osteogênese , Osteonecrose/terapia , Alicerces Teciduais , Animais , Modelos Animais de Doenças , Feminino , Masculino , Osteonecrose/etiologia , Ratos , Ratos Endogâmicos F344
12.
J Orthop Sci ; 23(2): 408-413, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29198491

RESUMO

BACKGROUND: Preoperative differential diagnosis between spinal meningioma and schwannoma is critical due to the characteristic differences of the surgical treatments. Thus, we aimed to develop an algorithm for the differential diagnosis of these two lesions based on plain MRI findings. METHODS: We retrospectively reviewed plain MR images from patients who had undergone surgical treatment for meningiomas and schwannomas in our hospital between 2002 and 2016. Seven findings characteristic of meningioma or schwannoma were considered: (a) low or equal signal intensity on T2-weighted images, (b) obtuse angle from the dura mater, (c) anterior location in the spinal canal, (d) cystic degeneration, (e) lumbar occurrence, (f) oval or round shape, and (g) dumbbell type. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of each MRI finding, following which the algorithm was developed using decision tree analysis. Finally, we examined the usefulness of the algorithm for differential diagnosis between the two lesions. RESULTS: Twenty four patients with meningiomas and 56 with schwannomas were enrolled. The sensitivity, specificity, PPV, NPV, and accuracy of each finding were as follows: (a) [58%, 100%, 100%, 85%, 88%], (b) [67%, 89%, 73%, 86%, 83%], (c) [29%, 88%, 50%, 74%, 70%], (d) [30%, 96%, 94%, 37%, 50%], (e) [43%, 96%, 96%, 42%, 59%], (f) [33%, 88%, 73%, 57%, 60%], and (g) [25%, 96%, 93%, 35%, 46%]. Significant differences were observed with regard to (a), (b), (d), (e), and (g). The algorithm was developed using these five findings, all of which exhibited high specificity and reliability. Accuracy of the algorithm was 91.3%. CONCLUSIONS: Our results indicated that plain MRI findings can be used to differentiate between spinal meningiomas and schwannomas. Furthermore, our novel algorithm exhibited high accuracy, suggesting that this algorithm may aid in the differential diagnosis of these two lesions.


Assuntos
Imageamento por Ressonância Magnética/métodos , Meningioma/diagnóstico por imagem , Neurilemoma/diagnóstico por imagem , Cuidados Pré-Operatórios/métodos , Neoplasias da Medula Espinal/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Biópsia por Agulha , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Masculino , Meningioma/diagnóstico , Meningioma/cirurgia , Pessoa de Meia-Idade , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Variações Dependentes do Observador , Estudos Retrospectivos , Neoplasias da Medula Espinal/diagnóstico , Neoplasias da Medula Espinal/cirurgia , Resultado do Tratamento
13.
Surg Neurol Int ; 15: 69, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38468645

RESUMO

Background: Although rare, cases of hypophysitis resembling a pituitary abscess (PA) have been reported. Differential diagnosis between hypophysitis and PA is crucial as the two diseases require different treatments. Case Description: A 38-year-old woman with headaches underwent head magnetic resonance imaging (MRI), which revealed an 11-mm mass lesion in the sella turcica. Due to breastfeeding, contrast-enhanced MRI was avoided. Pituitary adenomas and Rathke's cleft cyst (RCC) were suspected, and she was initially treated conservatively. Five months later, she acquired syndrome coronavirus two infections, and while the fever subsided with acetaminophen, the headache persisted. One month later, the headache worsened, followed by fever and diabetes insipidus. MRI revealed a pituitary cystic mass with ring-shaped contrast enhancement on T1-weighted MRI and increased signal intensity on diffusion-weighted imaging (DWI). PA was suspected, and emergency endoscopic transsphenoidal surgery was performed. The microbiological examination of the yellowish-brown content drained from the cystic mass was negative. Microscopically, the cystic lesion was covered with ciliated columnar epithelium and stratified squamous epithelium, with a dense inflammatory cell infiltrate consisting mainly of lymphocytes and plasma cells observed around the cyst. This supported the diagnosis of secondary hypophysitis associated with RCC without PA. Conclusion: We report a case of hypophysitis secondary to RCC resembling PA with ring-shaped contrast enhancement on MRI and increased signal intensity on DWI. This case emphasizes the need for cautious diagnosis of secondary hypophysitis due to RCC in individuals with MRIs and clinical manifestations resembling an abscess.

14.
Tomography ; 9(1): 285-298, 2023 01 30.
Artigo em Inglês | MEDLINE | ID: mdl-36828375

RESUMO

The loss of resistance (LOR) method has been used exclusively to identify epidural space. It is difficult to find the epidural space without the risk of dural puncture. Various devices have been developed to improve the accuracy of the LOR method; however, no method has overcome the problems completely. Therefore, we devised a ligamentum flavum rupture method (LFRM) in which the needle tip is placed only on the ligamentum flavum during the epidural injection, and the injection pressure is used to rupture the ligamentum flavum and spread the drug into the epidural space. We confirmed the accuracy of this method using ultrasound with superb microvascular imaging (SMI) to visualize the epidural space. Here, we report two cases of 63-year-old and 90-year-old males. The 63-year-old patient presented with severe pain in his right buttock that extended to the posterior lower leg. The 90-year-old patient presented with intermittent claudication every 10 min. LFRM was performed, and SMI was used to confirm that the parenteral solution had spread into the epidural space. Our results indicate that LFRM can be used for interlaminar lumbar epidural steroid injections.


Assuntos
Ligamento Amarelo , Masculino , Humanos , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Ligamento Amarelo/diagnóstico por imagem , Injeções Epidurais/métodos , Espaço Epidural/diagnóstico por imagem , Ultrassonografia , Agulhas
15.
Int J Surg Case Rep ; 103: 107884, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36696842

RESUMO

INTRODUCTION AND IMPORTANCE: Intracranial germinomas are germ cell tumors that commonly develop in the pineal or neurohypophysis regions. As ectopic germinomas are rarely observed within the cerebrum and are associated with atypical image findings, diagnosis is challenging. CASE PRESENTATION: A 14-year-old boy was admitted to our hospital with complaints of vomiting and headache. Gadolinium-enhanced magnetic resonance imaging revealed ring-enhancing lesions in his left frontal lobe and basal ganglia. Susceptibility-weighted imaging indicated that the subependymal veins passing through the lesion centers were engorged, while electrophoretic analysis of cerebrospinal fluid identified oligoclonal bands (OCBs); both were typical of multiple sclerosis (MS). Tumor biopsy revealed many cells with atypical mitotic figures and nuclear enlargements, suggesting malignant disease. As the tumor rapidly proliferated, we opted for surgical excision of the lesions. Histopathological analyses revealed "two-cell patterns" characteristic of germinoma. Immunohistochemistry was positive for placental alkaline phosphatase and c-KIT. The definitive diagnosis was germinoma. After chemoradiotherapy, the patient was discharged without neurological deficits. CLINICAL DISCUSSION: OCBs and several magnetic resonance imaging features (including open ring enhancement, T2 hypointense rims, mild mass effects, mild perilesional edema, peripheral restriction around the lesion, and vessel-like structures running through the lesion center) are useful diagnostic signs for the radiological discrimination of MS from germinoma. However, owing to these factors, some cases are difficult to diagnose. CONCLUSION: Our case report of an unusual ectopic cerebral germinoma illustrates the difficulty of distinguishing it from MS. Therefore, we recommend proper tissue sampling in such cases, especially in adolescent patients, to make definitive germinoma diagnoses.

16.
J Dent Anesth Pain Med ; 23(3): 153-162, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37313266

RESUMO

Background: Recent animal studies have suggested the role of GABA type A (GABA-A) receptors in salivation, showing that GABA-A receptor agonists inhibit salivary secretion. This study aimed to evaluate the effects of propofol (a GABA-A agonist) on salivary secretions from the submandibular, sublingual, and labial glands during intravenous sedation in healthy volunteers. Methods: Twenty healthy male volunteers participated in the study. They received a loading dose of propofol 6 mg/kg/h for 10 min, followed by 3 mg/kg/h for 15 min. Salivary flow rates in the submandibular, sublingual, and labial glands were measured before, during, and after propofol infusion, and amylase activity was measured in the saliva from the submandibular and sublingual glands. Results: We found that the salivary flow rates in the submandibular, sublingual, and labial glands significantly decreased during intravenous sedation with propofol (P < 0.01). Similarly, amylase activity in the saliva from the submandibular and sublingual glands was significantly decreased (P < 0.01). Conclusion: It can be concluded that intravenous sedation with propofol decreases salivary secretion in the submandibular, sublingual, and labial glands via the GABA-A receptor. These results may be useful for dental treatment when desalivation is necessary.

17.
J Orthop Surg Res ; 18(1): 847, 2023 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-37941032

RESUMO

BACKGROUND: Several methods can be used to diagnose discogenic pain, but only discoblock can diagnose discogenic pain definitively. This study aimed to examine the usefulness of an ultrasound-guided disc pain induction test for a simple and accurate diagnosis of the culprit lesion. METHODS: We included 41 patients with lumbar pain in whom pain was induced by an ultrasound-guided disc pain induction test. All patients had confirmed pain at L1/2 to L5/S1 based on an ultrasound-guided disc pain induction test and underwent X-ray photography and magnetic resonance imaging. Seventeen patients who required injection due to severe pain underwent discoblock procedures for discs with the most intense pain, and visual analogue scale (VAS) scores were obtained before and after the procedure for these patients. We analysed the association between painful discs and radiological findings. RESULTS: Pain induction was noted in a total of 65 discs, and the pain was induced in 23 patients in only one disc. All patients had disc degeneration of Pfirrmann classification grade 1 or higher, with more significant disc degeneration in painful discs than in painless discs. There was no significant relationship between the presence or absence of pain and Modic type. The average VAS measurements improved significantly from 9.5 (pre-procedure) to 2.5 (post-procedure). These results suggest that the most painful discs were the causes of discogenic lumbar pain. CONCLUSIONS: Our ultrasound-guided disc pain induction test may help diagnose disc degeneration and identify culprit lesions, even when multiple discs exhibit findings of degeneration.


Assuntos
Degeneração do Disco Intervertebral , Deslocamento do Disco Intervertebral , Disco Intervertebral , Dor Lombar , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/diagnóstico por imagem , Degeneração do Disco Intervertebral/patologia , Estudos Transversais , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Dor Lombar/diagnóstico por imagem , Dor Lombar/etiologia , Imageamento por Ressonância Magnética , Ultrassonografia de Intervenção , Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/diagnóstico por imagem
18.
Spine J ; 23(12): 1928-1934, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37479142

RESUMO

BACKGROUND CONTEXT: Lumbosacral fusion supplemented with sacropelvic fusion has recently been increasingly employed for correcting spinal deformity and is associated with lower incidence of pseudarthrosis and implant failure. To date, few studies have evaluated anatomical parameters and technical feasibility between different entry points for S2 alar-iliac screws. PURPOSE: To compare anatomical parameters and technical feasibility of two entry points for the S2 alar-iliac screw (S2AIS) in a Japanese cohort using three-dimensional (3D) computed tomography (CT). STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Fifteen men and 15 women aged 50-79 years who underwent pelvic CT at our hospital in 2013. OUTCOME MEASURES: Screw length, lateral angulation, caudal angulation, angle range, distance from the entry point to the sacroiliac joint, distance from the S2AIS to the acetabular roof, distance from the S2AIS to the sciatic notch, and insertion difficulty. METHODS: We used 30 pelvic CT images (15 men and 15 women). We selected two entry points from previous studies: one was 1 mm distal and 1 mm lateral to the S1 dorsal foramen (A group) and the other was the midpoint between the S1 and S2 dorsal foramen (B group). We resliced the plane in which the pelvis was sectioned obliquely from these entry points to the anterior inferior iliac spine in the sagittal plane. We placed the shortest and longest virtual S2AISs bilaterally in this plane using a 4-mm margin. We measured screw length, lateral angulation, caudal angulation, angle range, distance from the entry point to the sacroiliac joint, distance from the S2AIS to the acetabular roof, distance from the S2AIS to the sciatic notch, and insertion difficulty. These measurements were compared between Groups A and B. RESULTS: In group A, the angle in the sagittal plane was significantly smaller and the distance from the entry point to the sciatic notch was significantly longer than in group B. Group B demonstrated a significantly longer screw length, longer distance from the entry point to the sacroiliac joint, and longer distance from the entry point to the acetabular roof than group A. The rate of insertion difficulty of S2AIS was much higher in group A. CONCLUSIONS: Insertion of S2AIS from the midpoint between the S1 and S2 dorsal foramen compared with the entry at distal and lateral to S1 foramen enables insertion of longer screws with low insertion difficulty.


Assuntos
Sacro , Fusão Vertebral , Feminino , Humanos , Masculino , Parafusos Ósseos , População do Leste Asiático , Ílio/diagnóstico por imagem , Ílio/cirurgia , Estudos Retrospectivos , Sacro/cirurgia , Fusão Vertebral/métodos , Tomografia Computadorizada por Raios X , Pessoa de Meia-Idade , Idoso
19.
Trauma Case Rep ; 48: 100950, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37915536

RESUMO

Pediatric pure discoligamentous Chance-type injury is relatively rare and the appropriate surgical method has not yet been established, particularly, whether spinal fixation with fusion or without fusion is more effective. This case report describes a 10-year-old-boy who sustained an L2-3 pure discoligamentous Chance-type injury following a car accident and underwent an L2-3 posterior fixation without fusion. The implants were removed after eight months of an uneventful postoperative course. However, four months later, the kyphotic deformity recurred. Although the deformity gradually progressed over nine months, the patient remained neurologically intact and asymptomatic. This report suggests that fixation without fusion may not be appropriate in pediatric patients with pure discoligamentous Chance-type injuries. Spinal fixation with fusion may be recommended to prevent loss of correction and ensure secure stabilization.

20.
NMC Case Rep J ; 10: 273-278, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37953904

RESUMO

Herein, we report a case of carotid artery stenting with proximal flow protection for severe stenosis of the left internal carotid artery using transbrachial and transradial artery approaches. Because an abdominal aortic aneurysm was present, we avoided the transfemoral approach. The procedure was successfully performed with a combination of an 8-Fr balloon guide catheter and microballoon catheter on separate axes. No complications such as pseudoaneurysm, thrombosis, or dissection were observed at the puncture site. The patient was discharged without complications and showed good outcomes at 3 months. This technique may offer a useful alternative for patients with severe stenosis who cannot be treated using a femoral artery approach.

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