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ABSTRACT: BackgroundThe Disability of the Arm, Shoulder and Hand (DASH) questionnaire is a region-specific self-administered questionnaire that
consists of a disability/symptom (DASH-DS) scale, and two optional modules, the work (DASH-W) and the sport/music (DASH-SM)
modules. The DASH was cross-culturally adapted and developed by the Impairment Evaluation Committee, Japanese Society for
Surgery of the Hand. The purpose of this study was to test the reliability, validity, and responsiveness of the Japanese version
of DASH (DASH-JSSH).
MethodsA series of 72 patients with upper extremity disorders completed the DASH-JSSH, the medical outcomes study 36-item short-form
health survey (SF-36), and the Visual Analog Scale (VAS) for pain. Thirty-eight of the patients were reassessed for test-retest
reliability 1 or 2 weeks later. Reliability was investigated by reproducibility and internal consistency. To analyze the validity,
a principal component analysis and correlation coefficients between the DASH-JSSH and the SF-36 were obtained. Responsiveness
was examined by calculating the standardized response mean (mean change/SD) and effect size (mean change/SD of baseline value)
after carpal tunnel release of the 17 patients with carpal tunnel syndrome.
ResultsCronbach’s alpha coefficients in the DASH-DS and DASH-W were 0.962 and 0.967, respectively. The intraclass correlation coefficients
for the same were 0.82 and 0.85, respectively. The unidimensionality of the DASH-DS and DASH-W were confirmed. The correlations
between the DASH-DS score and the subscale of the SF-36 scale ranged from −0.29 to −0.73. The correlation coefficient between
the DASH-DS and the DASH-W was 0.79. The standardized response mean/effect size of DASH-DS, DASH-W, and VAS for pain were
−0.48/−0.26, −0.68/−0.41, and −0.40/−0.40, respectively. DASH-DS and DASH-W were as moderately sensitive as VAS for pain.
ConclusionThe DASH-DS and DASH-W Japanese version have evaluation capacities equivalent to those of the original and other language
versions of the DASH.
Journal of Orthopaedic Science 04/2012; 10(4):353-359. · 0.84 Impact Factor
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11/2011; , ISBN: 978-953-307-862-5
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ABSTRACT: Giant cell tumor (GCT) of the small bones (small-bone GCT) is usually rare and considered somewhat different from conventional GCT. The purpose of this study was to investigate and report the clinicopathological features of 11 cases with small-bone GCT.
Patient information was obtained with the help of questionnaires. X-rays and paraffin blocks obtained from several institutions were clinically, radiographically, and histologically evaluated.
Small-bone GCT was observed in younger patients compared to conventional GCT; 5 of the 11 (45%) patients were below 20 years of age, whereas the corresponding figure for all GCT patients is 16% in Japan. Excessive cortical bone expansion is a special feature. There were two cases of recurrence and one case of lung metastasis; the primary lesion was in the hand for all three cases. In contrast, no primary lesion of the foot recurred or metastasized. Varying degrees of positive p63 immunostaining were observed in all examined cases (n = 9) of small-bone GCT but were negative in case of giant cell reparative granuloma (GCRG) and solid variant of aneurysmal bone cyst (ABC). One case that demonstrated high-intensity positive staining had two episodes of recurrence.
Small-bone GCT tends to develop in younger patients than does conventional GCT. Primary GCTs of the hand may be biologically more aggressive than those of the feet. The p63 immunostaining may be useful not only for differential diagnosis but also for prognostication of small-bone GCT.
Upsala journal of medical sciences 09/2011; 116(4):265-8. · 0.73 Impact Factor
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ABSTRACT: Dedifferentiated liposarcomas usually occur in the retroperitoneal space and relatively rarely in the extremities.
We identified 18 patients with primary dedifferentiated liposarcoma in the extremities from the files of Tohoku Musculoskeletal Tumor Society and analyzed demographics, histologic findings, treatments and prognostic factors. The average follow-up period was 58 months.
The subjects were 12 men and 6 women with a mean age of 65 years. All tumors were in the thigh. Nine patients noticed a rapid enlargement of the long-standing tumor. Histologic subtypes of the dedifferentiated area were undifferentiated pleomorphic sarcoma (n = 12), osteosarcoma (n = 2), rhabdomyosarcoma (n = 2), leiomyosarcoma (n = 1) and malignant peripheral nerve sheath tumor (n = 1). In the patient with rhabdomyosarcoma-like dedifferentiated area, extensive necrosis was observed after the preoperative chemotherapy. One patient who underwent marginal excision developed a local recurrence, but inadequate surgical margin was not associated with a risk of local recurrence. Three patients had lung metastasis at initial presentation, and four other patients developed lung metastases during the follow-up period. The overall survival rate was 61.1% at 5 years. On univariate analyses, large size of the dedifferentiated area (>8 cm), high MIB-1-labeling index (>30%) for the dedifferentiated area and lung metastasis at initial presentation were significantly associated with poor prognosis.
Primary dedifferentiated liposarcoma in the extremities predominantly occurred in the thigh and a rapid enlargement of long-standing tumors was a characteristic symptom. Although the local behavior of these tumors was less aggressive than that of retroperitoneal dedifferentiated liposarcomas, they had a relatively high metastatic potential.
Japanese Journal of Clinical Oncology 07/2011; 41(9):1094-100. · 1.78 Impact Factor
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ABSTRACT: Vascularized bone grafts frequently are used to reconstruct bone defects after tumor resection if the expected prognosis is good. The most used bone is the fibula; however, other donor sites are available. Their vascularities are maintained by both free autografts and pedicled flaps, which preserve the vascular supply for bone union while preventing infection. The vascularized fibular graft is used for both primary reconstruction and salvage of failed oncologic long bone reconstruction and pathologic fractures. Various combination procedures with vascularized fibular grafts also have been reported in the recent literature with satisfactory clinical results. The second most commonly used donor material for free-vascularized bone transfer is the iliac bone with the deep circumflex iliac artery. Harvesting the iliac bone is relatively sophisticated; however, it may become easier by using prospective CT angiography and confirming the vascular supply which aids in planning. The use of allograft shells with intramedullary free vascularized bone grafts for intercalary reconstruction after excision of bone malignancy has been reported recently and takes advantage of the combination of both the strong bone stock provided by the allograft and the biological potentials provided by the vascularized bone graft. This article examines various vascularized bone grafts used to reconstruct massive bone defects after tumor resection or reconstructive procedures.
Current Orthopaedic Practice 06/2011; 22(4):309–314.
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Toshihiko Imaeda,
Shigeharu Uchiyama,
Takuro Wada,
Shuji Okinaga,
Takuya Sawaizumi,
Shohei Omokawa,
Toshimitsu Momose,
Hisao Moritomo,
Hiroyuki Gotani,
Yukio Abe, Jun Nishida,
Fuminori Kanaya
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ABSTRACT: The Patient-Rated Wrist Evaluation is a regionspecific, self-administered questionnaire consisting of a pain scale (PRWE-P) and a functional scale (PRWE-F), with the latter consisting of specific function (PRWE-SF) and usual function (PRWE-UF). The PRWE was cross-culturally adapted from the original English version by the Impairment Evaluation Committee, Japanese Society for Surgery of the Hand (JSSH). The purpose of this study was to test the reliability, validity, and responsiveness of the Japanese version of PRWE (PRWE-J).
A consecutive series of 117 patients with wrist disorders completed the PRWE-J, the JSSH version of the Disabilities of the Arm, Shoulder, and Hand (DASH-JSSH) questionnaire and the 36-Item Short-Form Health Survey (SF-36). Of the 117 patients, 71 were reassessed for test-retest reliability 1 or 2 weeks later. Reliability was investigated by reproducibility and internal consistency. To analyze the validity, a factor analysis (principal axis factoring) of PRWE-J and correlation coefficients between PRWE-J and DASH-JSSH were obtained. Responsiveness was examined by calculating the standardized response mean (SRM) (mean change/SD) and effect size (mean change/SD of baseline value) after open surgery in 50 patients.
Cronbach's alpha coefficients for PRWE-P, PRWE-F, and PRWE were 0.90, 0.95, and 0.95, respectively. The intraclass correlation coefficients (ICCs) for the same were 0.86, 0.93, and 0.92, respectively. Unidimensionality of PRWE-P was con-firmed. Bidimensionality of PRWE-F was confirmed and separated clearly into PRWE-SF and PRWE-UF. The correlation coefficients between PRWE-P and PRWE-F or DASH-JSSH were 0.63 or 0.63, respectively. The correlation coefficient between PRWE-F and DASH-JSSH was 0.80. The correlation coefficients between DASH-JSSH and PRWE-SF or PRWE-UF were 0.76 or 0.73, respectively. Moderate correlation was observed in "physical functioning" for SF-36 and PRWE-SF (r = -0.46), PRWE-F (r = -0.46), or PRWE (r = -0.46). The SRMs/effect sizes of PRWE-P, PRWE-F, or PRWE were respectively excellent: 1.7/2.2, 1.2/1.3, 1.6/1.9.
The PRWE-J has evaluation capacities equivalent to those of the original PRWE.
Journal of Orthopaedic Science 07/2010; 15(4):509-17. · 0.84 Impact Factor
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ABSTRACT: The authors hypothesized that an external fixator (EF) could compromise ROM compared with a volar locking plate (VP) because of the longer duration of immobilization using a VP. Postoperative ROM were therefore compared between the EF and the VP, focusing on the movement of the radiocarpal (RC) and midcarpal (MC) joints evident on radiology. The clinical outcomes of the two methods were also evaluated.
Functional radiographs were taken in active volar and dorsal flexions from both the injured and contralateral sides. Clinical outcomes in terms of grip strength, pulp pinch, Quick-DASH, and the modified Cooney evaluation were compared.
The average wrist volar flexion angle was significantly smaller on the injured side in both groups, significantly so in the VP group. No significant differences were seen in clinical outcome. Although distinct restriction of the wrist volar flexion angle was seen in patients treated with the VP, the Quick-DASH and the modified Cooney evaluation showed no difference between these two groups.
These results should be considered when performing surgical treatment for patients with distal radius fracture. These procedures should be adopted to complement each other according to local conditions and individual patient-related factors.
Medical science monitor: international medical journal of experimental and clinical research 05/2010; 16(5):CR207-12. · 1.70 Impact Factor
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ABSTRACT: Hibernoma is a rare adipose tissue tumor of the soft tissue and the term is derived from the histological similarities to the brown fat found in hibernating animals. It usually occurs in the interscapular area, back, and neck and a few cases have been reported in the buttock or thigh.
Two cases are presented, one of which had a lesion in the buttock and the other a lesion in the thigh. The lesion in the buttock extended into the pelvis. CT and MR findings suggested liposarcoma in both cases, but the uptake was extremely intense on 18F-FDG-PET in one case. This was not typical of liposarcoma and suggestive of hibernoma. Biopsy specimens revealed a proliferation of adipose cells with vacuolated granular eosinophilic cytoplasm. No cellular atypia or mitotic figures were observed in either case. A marginal excision was performed in one case and an intralesional excision in the other. There were no signs of local recurrence at the final follow-up.
While occurrences in the buttock or thigh are exceedingly rare, hibernoma should be included in the differential diagnosis of an adipose tissue tumor in the thigh, even though the imaging findings mimic liposarcoma. 18F-FDG-PET may be a very meaningful technique to differentiate hibernoma from liposarcoma. A correct diagnosis should be established to prevent over-surgery.
Medical science monitor: international medical journal of experimental and clinical research 08/2009; 15(7):CS117-22. · 1.70 Impact Factor
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ABSTRACT: In the treatment of grade 1 chondrosarcoma of long tubular bones, a wide excision with replacement by a metal prosthesis has been widely used. However, postoperative function of the affected extremity has occasionally been problematic.
In two cases of grade 1 chondrosarcoma, a 54-year-old man with a lesion in the mid humerus and a 17-year-old woman with the lesion in the proximal femur, we performed curettage with pasteurization in situ. In both cases, destruction of the cortical bone was limited on radiographs. Follow-up studies 11 years after surgery did not showed local recurrence or functional deficit in either case.
This less invasive surgical procedure has an advantage of sparing limb function and preventing local recurrence for grade 1 chondrosarcoma.
Medical science monitor: international medical journal of experimental and clinical research 03/2009; 15(3):CS44-8. · 1.70 Impact Factor
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ABSTRACT: Bone defect is a common problem encountered in the treatment of musculoskeletal tumor surgery. Allograft is a commonly used technique to reconstruct a large osseous defect following tumor excision in the United States and some European countries, and relatively good results have been reported because of its biologic nature. However, with the use of an allograft, there are concerns of transmission of infectious diseases, immunological reactions, and social or religious refusal in some regions in the world. Under these circumstances, vascularized autogenous fibular or iliac bone grafts are commonly used techniques and bone lengthening techniques using external fixation have been reported recently. These procedures utilize viable bone. In addition to these procedures, some biological reconstructive techniques utilizing nonviable bone have been performed as surgical alternatives for allografts using treated recycling bone including irradiated or pasteurized resected bone graft and reconstruction using an autograft containing tumor treated by liquid nitrogen. Although each technique has its proper advantages and disadvantages, the clinical results are similar to the allograft, and numerous techniques are now available as reasonable alternatives for allografts.
Medical science monitor: international medical journal of experimental and clinical research 09/2008; 14(8):RA107-13. · 1.70 Impact Factor
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Jun Nishida,
Tetsuro Morita,
Akira Ogose,
Kyoji Okada,
Hiroshi Kakizaki,
Takahiro Tajino,
Masahito Hatori,
Hiroshi Orui,
Shigeru Ehara,
Takashi Satoh,
Tadashi Shimamura
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ABSTRACT: Lipoma-like liposarcomas mimic deep-seated lipomas in regard to imaging as well as histological findings and occasionally cause problems concerning diagnosis and treatment. The differences in the imaging findings among these lesions are not well defined. The purpose of this study was to elucidate the differences among the deep-seated adipocytic neoplasms including intramuscular lipoma, intermuscular lipoma, and lipoma-like liposarcoma.
The imaging and clinicopathological findings of 40 intramuscular lipomas, 27 intermuscular lipomas, and 22 lipoma-like liposarcomas were evaluated, and the possibilities in the differential diagnosis were assessed.
Although the most frequent symptom was a palpable mass, swelling was a common symptom of intramuscular lipomas and lipoma-like liposarcomas. Imaging studies revealed dumbbell-shaped appearances among intermuscular lipomas, whereas spherical masses were characteristic of intramuscular lipomas and lipoma-like liposarcomas. Computed tomography and magnetic resonance imaging revealed fatty lesions containing streaky structures in benign lesions, and CT revealed foci of hazy amorphous density, representing spindle cell proliferation, in lipoma-like liposarcoma. Although streaky structures corresponding to entrapped muscle fibers were thick and occasionally interrupted in intramuscular lipomas, the streaky structures corresponding to areolar fibrous tissue were thin and were usually not interrupted in intermuscular lipomas. In lipoma-like well-differentiated liposarcomas, thick streaks represented entrapped muscle fibers, and thin streaks represented fibrous tissue or neoplastic spindle cell proliferation.
The imaging findings are helpful and often afford almost pathognomonic evidence of these lesions and could help with the selection of appropriate surgery.
Journal of Orthopaedic Science 12/2007; 12(6):533-41. · 0.84 Impact Factor
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ABSTRACT: The objective was to elucidate clinical and imaging features of skeletal involvement, recurrences, and metastases of extraskeletal myxoid chondrosarcoma.
Included in this series are 4 patients, aged 44 to 65 years, 3 of whom were men and 1 a woman.
The primary lesions were in the thigh (n = 3) and the upper arm (n = 1). Three patients with multiple metastases died of the disease, 2 were considered to have local recurrence in the adjacent bone. Skeletal metastases occurred after lung metastases in 2 cases, and before lung metastases in 1 case. Typical imaging findings are well-defined lesions with no sclerotic margin or matrix mineralization. A slow, but persistent growth is noted on the imaging features.
Although skeletal metastases of chondrosarcoma of bone and soft tissue are rare, myxoid chondrosarcomas, currently classified tumors of uncertain differentiation, rarely metastasize and/or recur in the bones. The imaging features are typically of a localized lesion with cortical disruption or expansion.
Skeletal Radiology 10/2007; 36(9):823-7. · 1.54 Impact Factor
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ABSTRACT: An 76-year-old man with an indolent soft tissue mass on the volar aspect of the left elbow was referred to our institution with a diagnosis of a soft tissue tumor. He had a history of lung tuberculosis since the age of 30. The mass was adjacent to the biceps brachi tendon. It demonstrated homogeneous low-signal intensity on T1-weighted magnetic resonance (MR) images and heterogeneous relatively high signal intensity with scattered low and high signal intensity areas on T2-weighted MR images. An excision was performed after needle biopsy with presumptive diagnosis of bicipitoradial bursitis. The histological specimen revealed an epithelioid cell granuloma with central necrosis. While the occurrence of tuberculous bicipitoradial bursitis has never been reported, this case demonstrates that it can be considered to be among the causes of a cystic lesion around the elbow joint.
Skeletal Radiology 06/2007; 36(5):445-8. · 1.54 Impact Factor
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ABSTRACT: Malignant peripheral nerve sheath tumor (MPNST) is a relatively rare soft tissue tumor, and its clinical relevance of pathological grades remains obscure.
Fifty-six cases of MPNST identified from the files of seven oncology centers of the Tohoku Musculoskeletal Tumor Society (TMTS) and National Cancer Center were analyzed for histologic grades, demographics, treatments, and prognostic factors. The average follow-up period was 41 months.
Twenty-two men and 34 women with a mean age of 45 years were involved. Forty-four (78.6%) of 56 tumors were in the lower extremity or trunk. Fifty tumors (89%) were classified as high grade, and the remaining six as low grade. Twenty-one (39.6%) of 53 patients who underwent tumor excision developed local recurrences. An axial site and inadequate surgical margin were defined as risk factors for local recurrence. The overall survival rates of the 56 patients were 55.1% at 3 years and 43.3% at 5 years. Univariate analysis of the 56 patients revealed large-sized tumors, metastasis at presentation, and histologically high grade were significantly associated with poor prognosis. Multivariate analysis revealed a large tumor and metastasis at presentation to be independent prognostic factors.
The current study involving 56 patients with MPNST showed the aggressive clinical behavior of the tumor. Large-sized tumors, metastasis at presentation, and high histological grade were related to poor prognosis on univariate analysis, but independency of histological grade was still obscure. In the treatment for a large and high-grade MPNST, an alternative strategy should be further considered.
Annals of Surgical Oncology 03/2007; 14(2):597-604. · 4.17 Impact Factor
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ABSTRACT: Discal cyst is a lumbar intraspinal cyst communicating with intervertebral disc, and previously reported series described the wall of these cysts as consisting of dense fibrous connective tissue. We report a 29-year-old Japanese male with discal cyst showing unusual histological features. Clinical symptoms in the current case as well as imaging features including discography were similar to those previously reported.However, the wall of the cyst consisted of disc material with myxoid degeneration. In addition, apoptosis of chondrocytes was diffusely observed in the herniated disc material. The current case was considered a histological variant of discal cyst. Myxoid degeneration of herniated disc material with diffuse apoptotic change of chondrocytes was probably associated with the formation of discal cyst.
Upsala journal of medical sciences 02/2007; 112(1):39-47. · 0.73 Impact Factor
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ABSTRACT: The Carpal Tunnel Syndrome Instrument (CTSI) is a disease-specific, self-administered questionnaire that consists of a symptom severity scale (SS) and a functional status scale (FS). The CTSI was cross-culturally adapted and developed by the Impairment Evaluation Committee, Japanese Society for Surgery of the Hand (JSSH). The purpose of this study was to test the reliability, validity, and responsiveness of the Japanese version of the CTSI (CTSI-JSSH).
A consecutive series of 87 patients with carpal tunnel syndrome completed the CTSI-JSSH, the JSSH version of the Disability of the Arm, Shoulder, and Hand questionnaire (DASH-JSSH), and the 36-Item Short-Form Health Survey (SF-36). Seventy-two of the patients were reassessed for test-retest reliability 1 or 2 weeks later. Reliability was investigated by the reproducibility and the internal consistency. To analyze the validity, a factor analysis (principal axis factoring) of the CTSI-JSSH and the correlation coefficients between the CTSI-JSSH and DASH-JSSH were obtained. The responsiveness was examined by calculating the standardized response mean (SRM; mean change/SD) and effect size (mean change/SD of baseline value) after carpal tunnel release in 42 patients.
Cronbach's alpha coefficients for the CTSI-JSSH-SS and the CTSI-JSSH-FS were 0.84 and 0.90, respectively, and the intraclass correlation coefficients were 0.82 and 0.83, respectively. The unidimensionality of the CTSI-JSSH-SS was barely confirmed; the unidimensionality of the CTSI-JSSH-FS was confirmed. The correlation coefficients between the CTSI-JSSH-FS and the CTSI-JSSH-SS or DASH-JSSH were 0.58 and 0.80, respectively. The correlation coefficient between the CTSI-JSSH-SS and DASH-JSSH was 0.54. The correlation coefficients between the subscales of SF-36 and the CTSI-JSSH-SS or the CTSI-JSSH-FS ranged from -0.23 to -0.66 and from -0.19 to -0.63, respectively. The SRMs/effect sizes of the CTSI-JSSH-SS and the CTSI-JSSH-FS were -0.85/-0.99 and -0.70/-0.61, which indicated that they were more than moderately sensitive.
The CTSI-JSSH has sufficient reliability, validity, and responsiveness to assess the health status in carpal tunnel syndrome.
Journal of Orthopaedic Science 02/2007; 12(1):14-21. · 0.84 Impact Factor
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Journal of Orthopaedic Science 01/2007; 12(1):107. · 0.84 Impact Factor
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ABSTRACT: Adhesion between the tendon and tendon sheath after flexor tendon graft inhibits restoration of excursion and strength of the grafted tendons, so post-operative finger function is occasionally unsatisfactory. Early setting rehabilitation is one important factor to prevent the adhesion, and another factor may be a lubricant. We considered the possibility of utilizing hyaluronic acid as a lubricant. The goal of this study is to investigate the in vitro effect of hyaluronic acid on tendon excursion resistance against a digital pulley in a modified human model.
The excursion resistance between grafted intrasynovial and extrasynovial tendons and A2 pulley were evaluated, and compared before and after soaking in 10 mg/ml hyaluronic acid.
The resistance increased after extrasynovial tendon graft, and then it decreased after soaking hyaluronic acid solution.
The evidence we collected suggests that some style of administration of the hyaluronic acid might reduce the excursion resistance in the tendon-pulley unit, facilitating post-operative rehabilitation and limiting adhesion, after tendon graft and possibly improve the clinical outcome of flexor tendon graft.
Clinical Biomechanics 11/2006; 21(8):810-5. · 2.07 Impact Factor
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ABSTRACT: We present the clinical outcome of five patients who had reconstruction of large osseous defects in the iliosacral region after excision of aggressive bone tumors using pedicled-or free-vascularized iliac bone grafts. Surgical margin, incidence of recurrence and metastasis, patient survival, time to bone union, and postoperative function were evaluated. Limb-salvage surgery resulted in wide excisions in two patients with giant-cell tumors of bone and chordoma, respectively, a marginal excision in one patient with a schwannoma, and intralesional excisions to preserve nerve roots in two patients with giant-cell tumors. There was no recurrence at final followup in any of the patients. Bone union required an average of 5.4 months. The postoperative functional results were excellent in all patients except for the patient with a chordoma. In one of the patients with a giant-cell tumor, the screws and rod were removed partially because of skin necrosis in the instrumentation area. This technique is considered a good alternative for reconstruction of a large osseous defect in the pelvis because graft harvest is relatively simple and rapid, especially if a pedicled iliac bone transfer is performed.
Clinical Orthopaedics and Related Research 07/2006; 447:145-51. · 2.53 Impact Factor
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ABSTRACT: The purpose of the present study was to test the responsiveness of the Japanese Society for Surgery of the Hand version of the Disability of the Arm, Shoulder and Hand questionnaire (DASH-JSSH) by evaluating effect size (ES) and standardised response mean (SRM) in patients undergoing carpal tunnel release. Subjects comprised 25 patients with carpal tunnel syndrome. All subjects completed the DASH-JSSH, medical outcomes 36-item short-form health survey (SF-36) and visual analogue scale (VAS) for pain and underwent objective assessment of grip strength, pinch strength and static two-point discrimination before and three months after surgery. DASH-JSSH displayed the highest sensitivity to changes at three months, followed by VAS. All subscales of SF-36 were much less sensitive and both grip and pinch strength were unchanged over the three-month period. DASH-JSSH demonstrated more responsiveness to changes after carpal tunnel release than SF-36, VAS and physical measurements, and displayed correlations with subscales of SF-36.
Hand Surgery 02/2006; 11(1-2):27-33.
