Shinji Yoshino

Changes in nitric oxide and expression of nitric oxide synthase in spinal cord after acute traumatic injury in rats.

The aim of this study was to observe the time course of NO production and NOS expression in the spinal cord following acute traumatic injury. Rat spinal cord was injured by extradural static weight-compression, which resulted in an incomplete transverse spinal cord lesion with paralysis of the lower extremities. Using this model, measurement of NO by microdialysis and Griess reaction and histological and immunohistochemical examinations using polyclonal antibodies to nNOS and iNOS were performed from immediately to 14 days after injury. In injured cord, the amount of NO markedly increased immediately after injury and gradually decreased between 1 and 12 h after injury. A second wave of increase in NO level was observed at 24 h and 3 days after injury. Histologically, hematomas and necrotic changes were observed after injury and demyelination of nerve fibers increased with time in the compressed segment. Immunohistochemically, the number of cells with expression of nNOS was increased immediately to 12 h after injury. Expression of iNOS was observed from 12 h to 3 days after injury. These findings suggested that the initial maximal increase of NO production might be caused mainly by nNOS and that the second wave of increase in NO might be due mainly to iNOS.

Posterior interosseous nerve syndrome with hourglass-like fascicular constriction of the nerve

We describe a case of the posterior interosseous nerve (PIN) syndrome in a patient with gout. Exploration of the PIN revealed multiple hourglass-like constriction of the PIN, which did not correspond to any extrinsic compressing structures. Hourglass-like constrictions of the PIN is one of the causes of the painful PIN syndrome.

Surgical Results of Lumber Fusion in Hemodialysis Patients

今回，透析患者に対する腰椎固定手術についてその手術成績と問題点について検討した．対象は，2002～2008年に手術を行った30例（男性15例，女性15例）であった．手術時年齢は52～72歳（平均61.8歳），透析歴は6ヶ月～31年（平均13年6ヶ月）であった．術前診断は，破壊性脊椎関節症（DSA）12例，腰椎変性すべり症10例，腰部脊柱管狭窄症4例，腰椎椎間板ヘルニア3例，分離すべり症1例であった．手術方法はPLF 24例，PLF+PLIF 4例，前方固定術2例であった．結果，JOAスコアの改善率50％以上が22例（73.3％）であったが，合併症による死亡が2例（6.7％）あった．透析患者に対する腰椎固定手術は合併症が多く，透析医，麻酔医との連携と十分なインフォームドコンセントが重要である．

A Case of Muscular Sarcoidosis.

Sarcoidosis is a granulomatous disease of unknown etiology. It commonly involves the pulmonary hilar lymph nodes, lungs, eyes, liver, and skin; however, skeletal muscles are rarely involved. We experienced a case of recurrent muscular sarcoidosis of the bilateral surae. The patient was a 57-year-old female, who presented masses with pain in her bilateral surae. Serological examination was within the normal range. MRI of the nodule showed a star-shaped area of lower signal intensity surrounded by an area of higher signal intensity. Marked uptake of 67 Ga was observed in these regions. Resection was performed on the right surae. Histological examinations showed granulomas composed of multinuclear giant cells and epithelioid cells. Sarcoidosis was diagnosed. Four months later, symptoms disappeared and the size of higher signal intensity area of the nodule reduced. MRI and 67 Ga scintigram were useful for diagnosis, and resection was successful in this patient.