Not only vitamin D but also statin may be a good choice in the management of patients undergoing transplantation.
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Animals↗
Biomedical subjects
Koichiro Ihara
Publications and source records attributed to Koichiro Ihara.
Microvascular anastomosis through the tibial tunnel: a new technique in free-tissue transfer to the leg.
Free-tissue transfer to a severely traumatized leg has a high rate of vascular complications. We present three successful cases using a new technique of microvascular anastomosis through the tibial tunnel. Because of the unavailability of anterior tibial artery due to posttraumatic vascular disease, donor vascular pedicles were passed posterior to the tibia through the tibial tunnel and anastomosed to the posterior tibial artery or its branch in an end-to-end fashion. The flaps survived perfectly, without any vascular complication. This technique represents a safe route, and the shortest route, to an expected anastomosis point. Our technique is indicated especially in cases with a single-vessel leg.
Adult↗
Effects of cessation of immunosuppression on skeleton reconstructed by vascularized bone allograft in rats.
In the present study, we investigated the effects of cessation of immunosuppression on skeleton reconstructed by vascularized allogenic bone transplantation in a rat tibio-fibula graft model. Twelve-week-old male 25 Dark Agouti rats with the major histocompatibility antigen (MHC) RT1a were used as donors and age-matched male 25 Lewis rats with MHC RT1l were used as recipients. Among them, 20 rats were randomly allocated to 8-week cyclosporine A (CsA) followed by 8-week CsA vehicle group or continuous 16-week CsA group. The remaining 5 rats received CsA for 8 weeks followed by no further treatment for next 40 weeks (long-term observation group). In the CsA followed by vehicle group as well as the continuous CsA group, the structure of the reconstructed bones was maintained, though the transplanted bones in former group were found to be partly non-vital. The CsA followed by vehicle group had higher bone mineral density of the transplanted bones and stronger strength of the reconstructed bones than the continuous CsA group. In the long-term observation group, the structure of the reconstructed bones was still maintained and the transplanted bones were almost vital. These results suggest that long-term strong immunosuppression may not be necessary for successful reconstruction of large bone defect by vascularized bone allograft.
Absorptiometry, Photon↗
Role of vascularised tissue transfer after oncological resection in the upper extremity.
We reviewed 12 patients who had had vascularised tissue transfer after oncological resection in the upper extremity. All patients had immediate reconstruction, and one had a double tissue transfer. Tissues used were skin flaps, free muscles, and vascularised fibulas, for resurfacing the wound, motor recovery, and reconstruction of large bony defects, respectively. All the patients returned early to their daily activities. Although local recurrences were encountered in two patients, they were again rendered disease-free by salvage operations. Two patients had secondary reconstructions using pedicle latissimus dorsi flaps for late problems, including one of the two patients who developed a local recurrence. The mean functional score using the system devised by the Musculoskeletal Tumor Society was 84%. All the upper extremities were successfully rescued with satisfactory function. Vascularised tissue transfer was invaluable for achieving both curative resection of the tumour and a useful upper extremity.
Adolescent↗
Posttraumatic radioulnar synostosis treated with a free vascularized fat transplant and dynamic splint: a report of two cases.
Two cases of posttraumatic radioulnar synostosis are presented. The patients were treated with excision of the cross-union and interposition of a free vascularized fat transplant. A newly devised pronation-supination dynamic splint was employed for 3 months postoperatively in both patients. After a 1-year postoperative follow-up, an increased range of motion was restored in both cases, and there was no evidence of recurrent synostosis formation in subsequent radiographs. We suggest that an interposed vascularized fat graft may be an ideal biologic barrier to fill the space created by cross-union excision.
Adult↗
Skeletal reconstruction by vascularized allogenic bone transplantation: effects of statin in rats.
BACKGROUND: Some statins have been reported to suppress the immune system and increase the expression of bone morphogenetic protein-2 gene that plays a pivotal role in bone regeneration. METHODS: The effects of cerivastatin on skeletal reconstruction by vascularized bone allograft were investigated in a rat tibia-fibula graft model. After transplantation, the recipient rats were treated with vehicle, low-dose cerivastatin, high-dose cerivastatin, or cyclosporine A. RESULTS: Transplanted bones treated with low-dose cerivastatin and vehicle failed to unite with the recipient bones. In contrast, high-dose cerivastatin induced the bone union as effectively as cyclosporine A. Histologically, high-dose cerivastatin-treated transplanted bones were nonvital, but new bone formation occurred at the outer layer of the nonvital cortex. CONCLUSION: These results indicate that statins could promote fracture healing. Because transplant recipients have the increased risks of osteoporotic fracture and hypercholesterolemia, statins may be a good choice in the treatment of these patients.
Animals↗
Ulnar variance and the role of joint levelling procedure for Kienböck's disease.
Forty patients with Kienböck's disease were reviewed to determine the relationship between ulnar variance and the development of Kienböck's disease in a Japanese cohort. The joint levelling procedures designed to correct ulnar variance were evaluated in 11 patients after a mean of 9.7 years following surgery. The mean ulnar variance was 0.50+/-1.67 in patients with Kienböck's disease and 0.56+/-1.76 in a control group. The onset of wrist symptoms in a younger age group was noticed after sports injuries, whereas older patients had no distinct history of trauma. Joint levelling procedures produced good clinical results, but carpal height ratio, Stahl's index and radioscaphoid angle were not improved, as evidenced radiographically. Our study suggests that in a Japanese cohort ulnar minus variance is not an important factor in the aetiology of Kienböck's disease. Although joint levelling procedures improved the clinical results, they did not reverse lunate collapse or carpal alignment.
Adolescent↗
Patellar tendon rupture and marked joint instability after total knee arthroplasty.
BACKGROUND: Patellar tendon rupture is a rare complication of total knee arthroplasty (TKA). Multiple repair methods have been described in the literature. METHODS: A 66-year-old woman suffered a patellar tendon re-rupture and marked joint instability within 6 months after revision TKA. She underwent re-revision TKA and extensor mechanism reconstruction with femoral quadriceps tendon and augmentation by a Leeds-Keio ligament. RESULT: It was fairly difficult to acquire a satisfactory range of motion as well as gain in knee extension capacity by eliminating the extension lag. CONCLUSION: Patellar tendon ruptures after TKA should be repaired as soon as they are recognized.
Aged↗
Carpal instability in rheumatoid wrists.
This study was conducted to identify patterns of carpal instability in the rheumatoid wrist. One hundred patients with proven rheumatoid arthritis were randomly chosen, and posteroanterior and lateral radiographs of right wrists were taken. The most common isolated pattern was volar intercalated segmental instability, apparent in 16 wrists, while nine wrists had scapholunate dissociations. Larsen grading scores revealed a correlation between disease duration, carpal height ratio, and ulnar translocation index. In the early stages of disease, the scapholunate angle was significantly increased and the lunate rotated volarly due to loosening of the intrinsic carpal ligament. In later phases, the capitolunate angle significantly increased and the capitate rotated dorsally. Patterns of carpal instability in rheumatoid wrists seem to be complicated, involving combined laxity of the intrinsic and extrinsic carpal ligaments.
Adult↗
Behavior of male-specific minor histocompatibility antigen in skin and limb transplantation.
BACKGROUND: Although the role of male-specific minor histocompatibility antigen H-Y has been increasingly understood in both experimental and clinical organ transplantation, little has been investigated on musculoskeletal tissue transplantation. This study was performed to describe the behavior of male-specific minor histocompatibility H-Y antigen in rat skin and whole limb transplantation. MATERIALS AND METHODS: Using three different strains of inbred rats (Lewis, F344, and Dark Agouti), 75 donor hindlimbs and eighteen skin grafts were isogenically transplanted to the sex-mismatched recipients. Recipients were observed up to 48 weeks postoperatively. Rejection was monitored by the appearance of the skin of the grafted limb and histology. Systemic microchimerism was assessed by polymerase chain reaction using Y-chromosome specific primers. RESULTS: Skin rejection didn't occur in all limb transplant recipients and histology did not show any rejection findings in all components of the limb graft through 48 weeks. Successful functional recovery was expected. Stable and high level of chimerism (>1%) was detected in the lymphoid tissues in nontreated female recipients. Male skin grafts were rejected by Lewis and F344 female recipients within 6 weeks postoperatively. All female skin grafts survived in male recipients. CONCLUSION: Our results suggest that H-Y antigen can induce graft rejection in rat skin graft but causes no rejection reaction in whole limb transplantation. Systemic chimerism may play an important role for acceptance of sex-mismatched limb graft.
Animals↗
Meniscal ossification.
Meniscal ossicles are rare in the human knee. We present one case. A 57-year-old taxi driver complained of right knee pain and swelling with radiographic findings of a meniscal ossicle. Arthroscopic inspection showed a degenerative and horizontal tear and calcium deposit at the middle and posterior thirds of lateral discoid meniscus. His lateral discoid meniscus, containing the ossicle, was removed. He was asymptomatic at a 3-year follow-up.
Arthralgia↗
Snapping knee caused by intra-articular tumors.
Locking of the knee can present with no history of antecedent injury. We identified impingement of intra-articular tumors in 2 cases. Intra-articular tumors are relatively rare. Mechanical symptoms were present in both cases. On physical examination, there was a palpable mass at the medial region of the patellofemoral joint. The interior had been replaced mainly by amorphous necrotic tissue. The definite diagnosis of a soft-tissue mass of the knee could not be made on histologic examination.
Adipose Tissue↗
Atypical palmar fibromatosis with giant fibrous nodule: a case report.
We present an unusual case of palmar fibromatosis. A 62-year-old man had a giant fibrous nodule in the deep fascia of the right palm without any pretendinous cord or flexion deformity at the metacarpophalangeal joint. Primarily soft-tissue tumor and palmar fibromatosis were considered as differential diagnosis of nodular mass but finally the latter was confirmed histologically after resection of the giant nodule.
Diagnosis, Differential↗
Recalcitrant posttraumatic nonunion of the humerus: 23 patients reconstructed with vascularized bone graft.
We treated 23 patients with recalcitrant posttraumatic humeral shaft nonunion with vascularized bone grafts (fibula 10, femur 10 and scapula 3). 21/23 patients healed primarily. Venous thrombosis in the graft necessitated postoperative thrombectomy in 2 patients. Complications at the donor site were trivial. We used a vascularized fibular graft in patients with a large bone defect and with poor intrinsic stability of the nonunion site and a corticoperiosteal femoral graft in atrophic nonunion without a substantial bone defect. The scapula graft is easy to transfer to the surgical neck of the humerus on its pedicle.
Adult↗
Tensor fasciae latae flap: long-term follow-up and refinement of its application.
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Fascia Lata↗
Pedicle or free musculocutaneous flaps for shoulder defects after oncological resection.
Management of soft-tissue defects of the shoulder is described. Extensive defects of soft tissues with or without overlying skin were created after resection of sarcomas in five patients. Reconstruction was performed using musculocutaneous flaps, which included three pedicle latissimus dorsi and two free tensor fascia lata flaps. Simultaneous functioning replacement of the defects of the trapezius and deltoid muscles were each achieved in two patients. Primary wound healing was achieved, and each patient recovered good contour of the shoulder. Functional results were satisfactory in all patients with an average score of 93.4% (range, 83%-100%) using the system of the Musculoskeletal Tumor Society. The four functioning muscles recovered active contraction in the transferred position. The shoulder elevation was normal in three patients, and was 90 degrees and 30 degrees in one patient each. All patients remained disease-free at the time of latest follow-up. Thus, shoulder defects of the soft tissues can be managed appropriately with the two representative musculocutaneous flaps.
Adolescent↗
The prognosis in spindle-cell sarcoma depends on the expression of cyclin-dependent kinase inhibitor p27(Kip1) and cyclin E.
The aim of the present study was to examine the prognostic significance of p27(Kip1) and cyclin E expression in patients with spindle-cell soft tissue sarcomas. In 46 cases of spindle-cell sarcoma including 17 pre-operative biopsy materials, the expression of p27(Kip1) and cyclin E was immunohistochemically examined. The expression of p27(Kip1) decreased in the nuclei of metastatic primary tumor cells (stage IV), whereas the expression of cyclin E increased in those lesions. On univariate analysis, when the expression of p27(Kip1) and cyclin E was analyzed together, patients with spindle-cell sarcoma exhibiting low expression of p27(Kip1) and high expression of cyclin E showed lower distant-metastasis-free survival (DMFS) and overall survival (OS) than those with other combinations of the two parameters (both P < 0.0001). Multivariate analysis revealed that patients with low p27(Kip1) and high cyclin E expression also showed a decrease in DMFS (P = 0.0007, relative risk = 21.3) and OS (P = 0.005, relative risk = 20.8). These results suggest that the combination analysis of p27(Kip1) and cyclin E expression even in biopsy specimens allows the prediction of the clinical behavior of spindle-cell sarcoma.
Cell Cycle Proteins↗
Scaphoid fracture in the young athlete--therapeutic outcome of internal fixation using the Herbert screw.
BACKGROUND: A fractured scaphoid is a common disabling injury occurring in contact sports. This study was designed to evaluate the therapeutic outcome of Herbert screw fixation for scaphoid fracture in young athletes. METHODS: Thirty athletes with 30 scaphoid fractures were treated. According to the Herbert classification, 10 were classified as acute fracture (group I), 6 as fibrous union (group II) and 14 as pseudoarthrosis (group III). Twenty scaphoid non-unions were due to missed diagnosis or unsuccessful immobilisation. RESULTS: Bony union was evident at an average of 9.2, 8.0 and 11.9 weeks postoperatively in groups I, II and III, respectively, and times for returning to sports were 10.7, 14.0 and 22.9 weeks. The clinical outcome assessed using the Mayo wrist score was excellent in groups I (97.5 points) and II (93.3) and good in group III (85.4). CONCLUSION: Early definitive diagnosis and treatment can allow early return to sports in young athletes. The Herbert screw technique produces an excellent clinical result for scaphoid fracture.
Adolescent↗