In the present study, we investigated whether both adipose-derived stem cell (ADSC) and osteogenic-induced ADSC sheets could promote bone healing in a rat distal femoral metaphysis bone defect model. ...A through-hole defect of 1 mm diameter was drilled into each distal femur of 12 week old rats. Forty-five rats were randomly assigned to three groups: (1) control group; (2) ADSC sheet group; or (3) osteogenic-induced ADSC sheet group. We evaluated each group by analysis of computerized tomography scans every week after the surgery, histological analysis, and DiI labeling (a method of membrane staining for post implant cell tracing). Radiological and histological evaluations showed that a part of the hole persisted in the control group at four weeks after surgery, whereas the hole was restored almost completely by new bone formation in both sheet groups. The mean value of bone density (in Houndsfield units) for the bone defect area was significantly higher in both sheet groups than that in the control group (p = 0.05) at four weeks postoperative. A large number of osteocalcin positive osteoblasts were observed at the area of bone defect, especially in the osteogenic-induced ADCS sheet group. DiI labeling in the newly formed bone showed that each sheet had differentiated into bone tissue at four weeks after surgery. The ADSC and the osteogenic-induced ADSC sheets promoted significantly quicker bone healing in the bone defect. Moreover, the osteogenic-induced ADSC sheet may be more advantageous for bone healing than the ADSC sheet because of the higher number of osteocalcin positive osteoblasts via the transplantation.
•We analyzed our surgical procedures and outcomes for refractory chronic subdural hematoma (CSDH).•Embolization of the middle meningeal artery may be suitable for refractory CSDH without organized ...hematoma.•We reviewed and discussed craniotomy and membranectomy for organized CSDH.•For refractory cases of organized CSDH, large craniotomy or mini-craniotomy assisted by endoscope may be suitable.
Refractory chronic subdural hematoma (CSDH) is rare but remains a difficulty for neurosurgeons, and no consensus on treatment procedures has been established. To discuss effective surgical procedures for refractory CSDH, we analyzed our surgical procedures and outcomes for refractory CSDH. We defined patients with refractory CSDH as those who presented with two or more recurrences. Fourteen patients with refractory CSDH were analyzed. Eight patients underwent burr-hole irrigation and closed-system drainage alone, four patients received embolization of the middle meningeal artery (MMA), and two patients with organized CSDH underwent large craniotomy with outer membranectomy as the third surgery. Two of the eight patients (25%) treated with burr-hole irrigation and drainage alone showed a third recurrence. No further recurrences were identified in patients treated with embolization of the MMA or craniotomy. However, statistical analysis showed no significant difference in cure rate between patients treated with burr-hole irrigation and drainage alone and patients treated with burr-hole irrigation and drainage with embolization of the MMA (P = .42). Similarly, no significant differences in cure rate were seen between patients treated with burr-hole irrigation and drainage alone and patients treated with craniotomy (P = .62). When selecting a surgical procedure, assessing whether the CSDH is organized is crucial. Embolization of the MMA may be considered as one of the optional treatments for refractory CSDH without organized hematoma. On the other hand, for refractory cases of organized CSDH, hematoma evacuation and outer membranectomy with large craniotomy or mini-craniotomy assisted by an endoscope may be suitable, as previous reports have recommended.
Soft tissue wounds with exposed bone often require extended healing times and can be associated with severe complications. We describe the ability of artificial dermis with autogenic adipose-derived ...stem cells (ADSCs) to promote the healing of wounds with exposed bone in a rat model.
Adipose tissues harvested from the bilateral inguinal regions of Wistar rats were used as ADSCs. Rats were randomly divided into control and ADSC groups to investigate the efficacy of ADSC transplantation for wound healing (n = 20 per group). Soft tissue defects were created on the heads of the rats and were covered with artificial dermis with or without the seeded ADSCs. Specimens from these rats were evaluated using digital image analysis, histology, immunohistochemistry, cell labeling, and real-time reverse-transcription polymerase chain reaction (real-time RT-PCR).
The average global wound area was significantly smaller in the ADSC group than in the control group on days 3, 7, and 14 after surgery (p<0.05). After 14 days, the blood vessel density in the wound increased by 1.6-fold in the ADSC group compared with that in the control group (p<0.01). Real-time RT-PCR results showed higher Fgfb and Vegf expression levels at all time points, and higher Tgfb1 and Tgfb3 expression levels until 14 days after surgery in the ADSC group than in the control group (p<0.05).
In wounds with exposed bone, autogenic ADSCs can promote vascularization and wound healing. Use of this cell source has multiple benefits, including convenient clinical application and lack of ethical concerns.
Background Concomitant intracranial chronic subdural hematoma (CSDH) and spinal subdural hematoma (SDH) are rare, and the etiology has yet to be elucidated. However, migration of the hematoma ...intracranially to a spinal site or coincidence of both intracranial and spinal CSDHs have been proposed as etiologies. We report a case of concomitant intracranial CSDH and spinal SDH in which spinal hematoma might have migrated from the cranial lesion. Case Description A previously healthy 58-year-old man with previous trauma to the occiput and lumbar spine suffered from headache, lumbago, and left hemiparesis. Head computed tomography revealed right-sided intracranial CSDH, and he underwent single burr-hole craniotomy. Although clinical symptoms tended to improve, left lower-limb weakness and lumbago remained. Spinal magnetic resonance imaging (MRI) 3 days after craniotomy revealed SDH extending from T1-S1. Because conservative therapy had not improved clinical symptoms, hematoma evacuation was performed via a left L5 hemilaminectomy 1 week after craniotomy. The patient showed complete recovery immediately postoperatively. Conclusions We reviewed the cases of 22 patients with concomitant intracranial CSDH and spinal SDH to discuss the features, etiology, and treatment strategy. Although surgical intervention was mainly selected for intracranial CSDH, conservative observation was mainly selected for spinal SDH. Outcomes were good in all patients. We created a new classification of spinal SDH shape using sagittal MRI. This classification indicates that cases with both ventral and dorsal SDH tend to require surgical intervention. This classification may help in deciding treatment strategies.
The current study aims to evaluate the incidence and results of aneurysmal subarachnoid hemorrhage (aSAH) throughout Kobe City. Based on a multicenter retrospective registry-based descriptive trial ...involving all 13 primary stroke centers in Kobe City, patients with aSAH treated between October 2017 and September 2019 were studied. A total of 334 patients were included, with an estimated age-adjusted incidence of 11.12 per 100,000 person-years. Curative treatment was given to 94% of patients, with endovascular treatment (51%) preferred over surgical treatment (43%). Of the patients, 12% were treated by shunt surgery for sequential hydrocephalus with a worse outcome at 30 days or discharge (14% vs. 46%, odds ratio (OR): 0.19, 95% confidence interval (CI): 0.088-0.39, p-value <0.001). As for vasospasm and delayed cerebral ischemia, most patients were given intravenous fasudil infusion (73%), with endovascular treatment for vasospasm in 24 cases (7.2%). The fasudil group had more good outcomes (42% vs. 30%, OR: 1.64, 95% CI: 0.95-2.87, p-value = 0.075) and significantly less death (3.3% vs. 35%, OR: 0.064, 95% CI: 0.024-0.15, p-value <0.001) at 30 days or discharge. Mortality rose from 12% at 30 days or discharge to 17% at 1 year, but neurological function distribution improved over time (modified Rankin Scale 0-2 was 39% at 30 days or discharge, 53% at 60 days, and 63% at 1 year). Our retrospective registered trial presented various statistics on aSAH, summarizing the current treatment status and prognosis.
Lateral column lengthening procedures are typically performed in patients with flatfoot deformity. There have been reports of complications caused by lateral column lengthening. In this study, ...clinical and radiographic osteoarthritis of the fourth and fifth tarsometatarsal joints were retrospectively assessed as complications after lateral column lengthening. Seventeen stage II flatfeet belonging to 15 patients were included. The mean age of the subjects was 64.2 ± 7.7 (range 52-80) years. The average lateral column lengthening length achieved was 12.7 ± 2.2 (range 8-15) mm. The average duration of follow-up postsurgically was 57.2 ± 37.7 (range 4-110) months. The pain group (n = 8), who postoperatively experienced weightbearing pain in the plantar-lateral aspect of the foot and/or tenderness at the dorsal-lateral, and the no-pain group (n = 9) were compared. All patients in the pain group underwent lateral column lengthening of 10 mm or more. However, there were no significant differences in age, body mass index, American Orthopaedic Foot and Ankle Society score, and the lateral column lengthening amounts between the groups. In the pain group, all patients had osteoarthritic changes in the fourth and fifth tarsometatarsal joints. In all subjects, 11 feet were diagnosed osteoarthritis. Patients with pain had a significantly lower postoperative first talometatarsal angle (p ≤ .05). Osteoarthritis of the fourth and fifth tarsometatarsal joints as complications after lateral column lengthening in flatfoot is first reported. Our study indicated a high possibility of osteoarthritis in patients who had pain in the lateral aspect of the foot after lateral column lengthening.
A healthy 23-year-old man suffered helmet-to-helmet collisions with an opponent during American football game twice within 3 days. He then experienced continuous vomiting and dizziness. Magnetic ...resonance imaging revealed acute infarction in the right cerebellar hemisphere, and magnetic resonance angiography revealed transient stenosis of the right superior cerebellar artery. Although minor head injury is not usually accompanied by complications, posttraumatic ischemic stroke has been reported on rare occasions. We report a case of cerebellar infarction after repeated sports-related minor head injuries in a young adult and discuss the etiology.
The incidence of intramedullary spinal cord metastasis (ISCM) has been increasing because the overall survival of patients with cancer has improved thanks to recent advanced therapies, such as ...molecular targeted drugs, anticancer agents, and various irradiation techniques. ISCM from lung and breast cancer is the most common form among cases of ISCM. We report an extremely rare form of ISCM from gastric cancer. This 83-year-old man who had a past medical history of gastric adenocarcinoma presented with acute onset of paraparesis. Spinal magnetic resonance imaging revealed an intramedullary lesion at the upper thoracic level. Due to rapid worsening of his paresis, we decided to perform tumor extirpation. Gross total resection of the tumor was successfully performed. Pathological examination revealed poorly differentiated adenocarcinoma, suggesting the diagnosis of ISCM from gastric cancer. He demonstrated gradual improvement of paraparesis soon after surgery, although his overall survival was limited to about 6 months after surgery. When examining the etiology of acute paraparesis in elderly patients with a past medical history of cancer, ISCM should be considered in the differential diagnosis. The prognosis of ISCM from gastric cancer is still extremely limited. Unfortunately, there is currently no treatment with proven efficacy. Surgery for ISCM from gastric cancer, although a challenging procedure for spine surgeons, should be considered as a therapeutic option in these patients.
Although an asymptomatic spinal dural arteriovenous fistula (SDAVF) can sometimes be incidentally detected on magnetic resonance imaging (MRI), there are no previous reports showing the development ...of an SDAVF on MRI or magnetic resonance angiography (MRA).
A 64-year old man with unruptured vertebral artery dissection (VAD) developed a subarachnoid hemorrhage (SAH) during regular follow-up. Emergent endovascular coil internal trapping for the VAD was performed; however, angiography after the endovascular treatment showed a lower cervical SDAVF. The SDAVF was considered the bleeding source based on subsequent spinal MRI, and endovascular embolization was performed. In this case, previous serial MRA examinations indicated that the SDAVF appeared for the first time during follow-up, and SAH occurred.
This may be the first report in which serial MRA studies demonstrated the course of this condition, from the appearance of an SDAVF to the development of SAH. An abnormal vascular structure detected on MRA indicated abnormal enlargement of the perimedullary vein and the presence of a cervical SDAVF. A lower cervical SDAVF should be suspected if such an abnormal vascular structure is detected on MRA.
Primary intraventricular oligodendroglioma (IVO) is a rare form of clear cell neoplasm and diagnosis is challenging because other clear cell neoplasms such as central neurocytoma must be ruled out. ...We report a case of primary IVO in which Olig2 immunohistochemistry was useful for the diagnosis. A 33‐year‐old man was admitted to our hospital with severe headaches due to an intraventricular mass lesion and underwent total resection of the mass lesion. The histological diagnosis was oligodendroglioma because the tumor was negative for synaptophysin and positive for Olig2. IVO is rare and differential diagnoses must be considered. The correct pathologic diagnosis is essential for anticipating the prognosis and selecting adjuvant therapy. In this case, Olig2 was useful for the diagnosis of oligodendroglioma.
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