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New method of local adjuvant therapy with bicarbonate Ringer’s solution for tumoral calcinosis: A case report

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World Journal of Orthopedics 2024年第3期15卷 302-309页

作者： Takashi Noguchi Akio sakamoto Kensaku Kakehi shuichi Matsuda Department of Orthopaedic Surgery Graduate School of MedicineKyoto UniversityKyoto 606-8507Japan

BACKGROUND Tumoral calcinosis is a condition characterized by deposits of calcium phosphate crystals in extra-articular soft tissues,occurring in hemodialysis *** phosphate crystals are mainly composed of hydroxyapatite,which is highly infilt-rative to tissues,thus making complete resection *** adjuvant method to remove or resolve the residual crystals during the operation is *** SUMMARY A bicarbonate Ringer’s solution with bicarbonate ions(28 mEq/L)was used as the *** resecting calcium phosphate deposits of tumoral calcinosis as much as possible,while filling with the solution,residual calcium phosphate deposits at the pseudocyst wall can be gently scraped by fingers or gauze in the operative field.A 49-year-old female undergoing hemodialysis for 15 years had swelling with calcium deposition for 2 years in the shoulders,bilateral hip joints,and the right foot.A shoulder lesion was resected,but the calcification remained and early re-deposition was *** the difficulty of a complete rection,we devised a bicarbonate dissolution method and excised the foot *** resection of the calcified material,the residual calcified material was washed away with bicarbonate Ringer’s *** The bicarbonate dissolution method is a new,simple,and effective treatment for tumoral calcinosis in hemodialysis patients.

关键词： Tumoral calcinosis Adjuvant therapy Bicarbonate Ringer’s solution Surgery Case report

Non-ossifying fibromas: Case series, including in uncommon upper extremity sites

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World Journal of Orthopedics 2017年第7期8卷 561-566页

作者： Akio sakamoto Ryuzo Arai Takeshi Okamoto shuichi Matsuda Department of Orthopaedic Surgery Graduate School of Medicine Kyoto University

AIM To investigate non-ossifying fibromas(NOFs) common fibrous bone lesions in children that occur in bones of the lower *** We analyzed 44 cases of NOF including 47 lesions, which were referred with a working diagnosis of neoplastic lesions. Lesions were located in the upper extremities(1 proximal humerus, 1 distal radius) and the lower extremities(25 distal femurs, 12 proximal and 4 distal tibias, and 4 proximal fibulas).RESULTS Three cases had NOFs in multiple anatomical locations(femur and fibula in 1 case, femur and tibia in 2 cases). Overall, larger lesions > 4 cm and lesion expansion at the cortex were seen in 21% and 32% of cases, respectively. Multiple lesions with bilateral symmetry in the lower extremities suggest that these NOFs were developmental bone defects. Two patients suffered from fracture and were treated without surgery, one in the radius and one in the femur. Lesions in the upper extremities(i.e., humerus of a 4-year-old female and radius of a 9-year-old male) expanded at the cortex and lesion size increased with slow *** NOFs in the lower extremity had fewer clinical problems, regardless of their size and expansiveness. In these two upper extremity cases, the NOFs had aggressive biological features. It seems that there is a site specific difference, especially between the upper extremity and the lower extremity. Furthermore, NOFs in the radius are predisposed to fracture because of the slender structure of the radius and the susceptibility to stress.

关键词： Non-ossifying fibroma Humerus Radius Fibula Upper extremity

System describing surgical field extension associated with flap reconstruction after resection of a superficial malignant soft tissue tumor

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World Journal of Clinical Oncology 2023年第11期14卷 471-478页

作者： Akio sakamoto Takashi Noguchi shuichi Matsuda Department of Orthopaedic Surgery Graduate School of MedicineKyoto UniversityKyoto 606-8507Japan

BACKGROUND Flap reconstruction after resection of a superficial malignant soft tissue tumor extends the surgical field and is an indicator for potential recurrence *** To describe a grading system for surgical field extension of soft tissue *** Grading system:CD-grading is a description system consisting of C and D values in the surgical field extension,which are related to the compartmental position of the flap beyond the nearby large joint and deeper extension for the pedicle,respectively.C1/D1 are positive values and C0/D0 are *** a known location,1/0 values can be"p"(proximal),"d"(distal),and"b"(in the tumor bed),and the description method is as follows:flap type,CxDx[x=0,1,p,d or b].RESULTS Four representative patients with subcutaneous sarcomas who underwent reconstruction using fasciocutaneous flaps are *** cases involved a distal upper arm(elbow)synovial sarcoma reconstructed using a pedicled latissimus dorsi(pedicled flap:CpDp);a distal upper arm(elbow)pleomorphic rhabdomyosarcoma reconstructed using a transpositional flap from the forearm(transpositional flap:CdD0);an undifferentiated pleomorphic sarcoma in the buttocks reconstructed using a transpositional flap(transpositional flap:C0D0);and a myxofibrosarcoma in the buttocks reconstructed using a propeller flap from the thigh(pedicled flap:CdDd).CONCLUSION The reconstruction method is chosen by the surgeon based on size,location,and other tumor characteristics;however,the final surgical field cannot be determined based on preoperative images ***-grading is a description system consisting of C and D values in the surgical field extension that are related to the compartmental position of the flap beyond the nearby large joint and deeper extension for the pedicle,*** CD-grading system gives a new perspective to the flap reconstruction *** CD-grading system also provides important information for follow-up imaging of a possible recurrenc

关键词： Soft tissue Sarcoma Surgery Sarcoma Grading system Surgical flap

Multistep hepatocarcinogenesis from a dysplastic nodule to well-differentiated hepatocellular carcinoma in a patient with alcohol-related liver cirrhosis

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World Journal of Gastroenterology 2007年第8期13卷 1271-1274页

作者： Soo Ryang Kim Hirotsugu Ikawa Kenji Ando Keiji Mita shuichi Fuki Michiie sakamoto Yoshihiro Kanbara Toshiyuki Matsuoka Masatoshi Kudo Yoshitake Hayashi Department of Gastroenterology Kobe Asahi Hospital Japan Department of Pathology Keio University School of Medicine Japan Department of Surgery Hyogo Medical Center for Adults Japan Department of Radiology Osaka City University Medical School Japan Department of Gastroenterology Kinki University School of Medicine Japan Division of Molecular Medicine & Medical Genetics International Center for Medical Research and Treatment Kobe University Graduate School of Medicine Japan

We describe a rare case of the transformation of a dysplastic nodule into well-differentiated hepato- cellular carcinoma (HCC) in a 56-year-old man with alcoholrelated liver cirrhosis. Ultrasound (US) disclosed a 10 mm hypoechoic nodule and contrast enhanced US revealed a hypovascular nodule, both in segment seven. US-guided biopsy revealed a high-grade dysplastic nodule characterized by enhanced cellularity with a high N/C ratio, increased cytoplasmic eosinophilia, and slight cell atypia. One year later, the US pattern of the nodule changed from hypoechoic to hyperechoic without any change in size or hypovascularity. US-guided biopsy revealed well-differentiated HCC of the same features as shown in the first biopsy, but with additional pseudoglandular formation and moderate cell atypia. Moreover, immunohistochemical staining of cyclase- associated protein 2, a new molecular marker of well- differentiated HCC, turned positive. This is the first case of multistep hepatocarcinogenesis from a dysplastic nodule to well-differentiated HCC within one year in alcohol-related liver cirrhosis.

关键词： Multistep hepatocarcinogenesis Dysplastic nodule Well-differentiated hepatocellular carcinoma Alcohol-related liver cirrhosis Cyclase-associated protein 2

Well to moderately differentiated HCC manifesting hyperattenuation on both CT during arteriography and arterial portography

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World Journal of Gastroenterology 2007年第43期13卷 5775-5778页

作者： Soo Ryang Kim Susumu Imoto Hirotsugu Ikawa Kenji Ando Keiji Mita shuichi Fuki Michiie sakamoto Yoshihiro Kanbara Toshiyuki Matsuoka Masatoshi Kudo Yoshitake Hayashi Department of Gastroenterology Kobe Asahi Hospital Kobe 653-0801 Japan Department of Pathology Keio UniversitySchool of Medicine Tokyo 160-8582 Japan Department of Surgery Hyogo Cancer Center Akashi 673-0021 Japan Department of Radiology Osaka CityUniversity Medical School Osaka 545-8586 Japan Department of Gastroenterology Kinki University School of Medicine Osaka-Sayama 589-8511 Japan Division of Molecular Medicine & MedicalGenetics International Center for Medical Research andTreatment Kobe University Graduate School of Medicine Kobe650-0017 Japan

We present a rare case of well-to moderately-differentiated hepatocellular carcinoma (HCC) in a 71-year-old woman with hepatitis C virus-related cirrhosis and unusual radiologic features. A 20-mm hypoechoic nodule disclosed by ultrasound in segment two showed hyperattenuation on both computed tomography hepatic arteriography and computed tomography during arterial portography. Contrast-enhanced ultrasound revealed hypervascularity in the early vascular phase and defect in the post-vascular phase, with the same pattern detected by the two imaging techniques. SPIO-MRI revealed a hyperintense nodule. These findings were compatible with those of moderately-differentiated HCC. An ultrasound-guided biopsy showed histological features of well-to moderately-differentiated HCC characterized by more than two-fold the cellularity of the non-tumorous area, fatty change, clear cell change and mild cell atypia with a thin to mid-trabecular pattern. Further studies may provide insights into the correlation between tumor neovascularity in multistep hepatocarcinogenesis and dual hemodynamics, including the artery and the portal vein.

关键词： Hepatocarcinogenesis, CT hepaticarteriography, CT during arterial portography Hperattenuation, Dual hemodynamics Well- tomoderately-differentiated hepatocellular carcinoma