Search

Spinal epidural abscess (SEA) is a rare condition, and a delay in its diagnosis causes paralysis. In this study, we report two rare cases of delayed diagnosis of SEA whose conditions improved after a state of complete paralysis. The first case was a 71-year-old diabetic man who received a corticosteroid injection for shoulder pain that caused intensified pain. Thereafter, the patient developed paralysis of both legs in stage IV according to Heusner staging. Subsequently, he was diagnosed with multiple abscesses and sepsis. He was in a poor state of health. Therefore, we treated his epidural abscess conservatively. After a month, his muscle strength had improved to Heusner stage III-A, and he was transferred to another hospital. The second case was a 64-year-old diabetic man who received an epidural corticosteroid injection for lower back pain. However, the pain intensified and was admitted to the hospital for pyelonephritis. He developed paralysis in both of his arms and legs presenting as a Heusner stage IV, caused by a cervical epidural abscess. A laminoplasty was performed and paralysis was improved. However, the patient subsequently developed a left subcortical hemorrhage. He underwent surgery. However, his right hemiplegia persisted, and on Day 21, he was transferred back to the previous hospital with a Heusner III-A. We could improve the patients’ paralysis by cooperating closely with infectious disease specialists and spine surgeons, taking intensive care, applying antibacterial agents appropriately, and operating quickly.

Background: Clinicians may choose to administer antiplatelet medications to patients with cerebral aneurysms following endovascular coiling to prevent thrombus formation and vascular occlusion, if they fear a thrombus will form on the platinum wire where it diverges into the vessel from the aneurysm sac. However, the mechanism by which vascular endothelial cells repair a vessel in the living body in the event of a coil deviation and the effects of antiplatelet drugs on these cells have not been fully elucidated. We aimed to investigate the association between endothelial progenitor cells (EPCs) and endothelium formation at the surface of the platinum coils deployed in the carotid artery of rats, and to determine the effects of different antiplatelet drugs on this process. Subjects and Methods: We established an experimental model using normal and diabetic rats at 12 months of age. The diabetic rats were assigned to 4 different diet groups, distinguished by whether they were fed plain rat feed, or the same feed supplemented by 1 of 3 antiplatelet drugs (cilostazol, aspirin, or clopidogrel: all 0.1%) for 2 weeks, and the carotid artery was perforated by an embolization coil (“carotid coil model”). We monitored the process by which vascular endothelial cells formed the new endothelium on the surface of the coil by sampling and evaluating the region at 1, 2, and 4 weeks after placement. This repair process was also compared among 3 groups treated with different antiplatelet drugs (i.e. aspirin, clopidogrel, and cilostazol). One-way analysis of variance tests were performed to evaluate the differences in vascular thickness between groups, and P Results: The diabetic rats showed delayed neoendothelialization and marked intimal hyperplasia. Cilostazol and clopidogrel effectively counteracted this delayed endothelial repair process. Flk1 immunostaining revealed greater expression in the diabetic rats administered cilostazol, second only to normal rats, suggesting that this agent acted to recruit EPCs. Conclusion: Neoendothelialization is delayed when vascular endothelial cells fail to function normally, which consequently leads to the formation of hyperplastic tissue. Cilostazol may remedy this dysfunction by recruiting EPCs to the site of injury.

Background Paravertebral compartment syndrome occurring without trauma is quite rare. We report a case of compartment syndrome that occurred after spinal exercises. Case presentation A 23-year-old Japanese rower developed severe back pain and was unable to move 1 day after performing exercises for the spinal muscles. Initial evaluation at a nearby hospital revealed hematuria and elevated creatine phosphokinase levels. He was transferred to our hospital, where magnetic resonance imaging revealed no hematoma but confirmed edema in the paravertebral muscles. The compartment pressure measurements were elevated bilaterally. Despite his pain being severe, his creatine phosphokinase levels were expected to peak and decline; his urine output was normal; and surgery was undesirable. Therefore, we opted for conservative management. The next day, the patient’s compartment pressure diminished, and his pain levels decreased to 2/10. After 5 days, he was able to walk without medication. Conclusions We present a rare case of compartment syndrome of the paravertebral muscles with good resolution following conservative management. We hope our case findings will help avoid unnecessary surgery in cases of paravertebral compartment syndrome.

We report a 76 -year-old woman with rheumatoid arthritis for 20 years, who gradually experienced dull pain in her leg thigh and general fatigue. She was gaven medicine at a near by hospital. But due to worsening conditions, she was introduced to our hospital. On the same day she visited our hospital, she reguired relaxation and debridement. Bacteriological examination showed the existence of group A Streptococci in the lesion, and we diagnosed this case as toxic shock like syndrome.Treatment with high-dose penicillin, clindamycin, and globulin were effective. After one month, she underwent skin graft from another thigh. After three months, she was able to walk for herself and was discharged. We considered it is important to diagnose her illness as Group A Streptococcus Infection.

External fixator is essential for unstable fracture of the distal radius. From January 1997 to December 2000, we treated 12 distal radius fractures with the Poanfix external fixtor. They included 1 male and 11 females aged 64 years on average. We classified them by Frykman's classification. To assess maintenance of reduction, ulnar variance (UV), palmar tilt, radial tilt, and carpal height ratio were measured before reduction and after removal of the external fixator. Clinical results by Saito's point system were excellent in 7 cases, good in 4, poor or fair in none, indicating results were satisfactory. X-p showed that palmar tilt and radial tilt did not differ significantly between before and after removal of the fixator. But 5 cases had UV greater than 2 mm. Two groups with more or less 2mm UV had different mean age and duration of external fixtor. The reason is suspected to be bone defect of distal radius due to osteoporosis. Consequently, we recommend a supplyment ary operation with external fixator for patients with radial fracture developing osteoporosis.

In this study we analyzed 70 patients with lumbar disc herniation treated by blocks since 1996. Fifty-one patients were treated by selective nerve root blocks and 19 were treated by continuous lumbar epidural blocks. The purpose of this paper is to compare the efficacy of the selective nerve root block and continuous epidural block. The functional results were evaluated on the basis of the Japanese Orthopaedic Association (JOA) score, subjective symptoms: 9 points. We assessed the block effectiveness when the JOA score improved by more than 2 points after the blocks. It was effective in 31 patients (60.8%) for selective nerve root blocks and 8 patients (42.1%) for continuous epidural blocks. Selective nerve root block is considered to be superior to continuous epidural block. Selective nerve root block showed better results especially for patients with negative SLR test. The herniated mass was protrusion type and space-occupying ratio was less than 30%.

We investigated 24 patients with skeletal tuberculosis in the past 20 years. The age range was from 24 to 86 years (average: 57.2 years). Half of the patients (12 cases) were tuberculous spondylitis. Of nine cases excluding the tuberculous spondylitis cases, three were tenosynovitis and two were psoitis. There was no tuberculous arthritis of the hip and knee joint. Tuberculin reaction was considered to be useful for screening inspection in the diagnosis of skeletal tuberculosis because it was positive in 70% of these patients. If swelling without heat or redness that does not react to antibiotics is seen, tuberculosis should be suspected.

The influence of glucocorticoid (GC) on bone in rats at different ages was investigated in order to provide insight into human glucocorticoid induced osteoporosis (GCOP). Three-, 6-, and 12-month-old female Wistar rats were divided into four groups: Zero-time control (ZT), vehicle (Cont), prednisolone (PSL) 2 mg/kg (P-L), PSL 20 mg/kg (P-H). PSL was subcutaneously administered every day for 4 weeks. Bone mineral density (BMD) at the proximal metaphysis and diaphysis of the tibia was measured by peripheral quantitative computed tomography. Histomorphometry of the tibia was performed for 3- and 6-month-old rats. GC increased trabecular and cortical BMD at the metaphysis in all 3-month-old rats with time. Trabecular BMD at the metaphysis in the P-L and P-H groups was significantly higher than in the control group. Histomorphometric parameters for both bone formation and resorption were also increased by GC treatment. In the 6-month-old rats, the metaphyseal trabecular BMD did not significantly change in any group, but the diaphyseal trabecular BMD significantly increased in the control group with time. The trabecular BMD of the metaphysis and diaphysis was significantly lower in the P-L and P-H groups than in the control group at week 4. Histomorphometric parameters for bone formation and resorption were both reduced by GC treatment. The BMD remained unchanged in all 12-month-old rats. Six-month-old rats treated with 20 mg/kg GC are suitable models for GC-induced osteoporosis with dominant cancellous bone decrease and reduced bone turnover. The pathology induced by 20 mg/kg prednisolone in 6-month-old female rats seems to be most similar to glucocorticoid-induced osteoporosis in humans.