Anderson, United States
Anderson, United States

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Nakae S.,BellLand General Hospital | Inoue M.,Kyoto Kuramaguchi Medical Center | Tadaki N.,Saiseikai Shigaken Hospital
Practica Oto-Rhino-Laryngologica | Year: 2017

An 8-year-old girl was brought to the emergency room of our hospital with a right temporal bone fracture sustained when she received a strong blow to the right side of her head in a traffic accident. She was found to have total right facial palsy on the following day, and was referred to the otolaryngological department 3 days after the injury. Decompression surgery of the right facial nerve was attempted 5 days after the injury, however, at surgery, the patient was found to have developed complete neurotmesis of the facial nerve in the horizontal portion, with a defect about 20 mm in length, caused by the impact of the temporal bone fragments. This was a very rare case of traumatic facial palsy caused by a temporal bone fracture. The great auricular nerve was used to reconstruct the facial nerve. The nerves were not sutured to each other, but stuck to each other with fibrin glue. Approximately a year after the operation, the paralysis grade had improved from grade IV to grade III (House-Brackmann grade), and the Yanagihara score from 0 to incision 24. In a case presenting with severe temporal bone fracture, it is necessary to recognize the possibility of neurotmesis of the facial nerve and prepare to reconstruct the facial nerve. Various methods of reconstruction of the facial nerve have been discussed in the literature. Transplantation of the great auricular nerve in the present case was very simple and resulted in a good outcome.


PubMed | Osaka Rosai Hospital, Bellland General Hospital, Kouseikai Takeda Hospital, Nara Prefecture Western Medical Center and 2 more.
Type: Journal Article | Journal: Journal of cardiology | Year: 2016

Excimer laser coronary atherectomy (ELCA) recently became available in Japan, but ELCAs effectiveness and safety are not clear.We enrolled consecutive patients who underwent ELCA and were registered in the Utility of Laser for Transcatheter Atherectomy-Multicenter Analysis around Naniwa (ULTRAMAN) registry comprising six Japanese medical centers around Naniwa in Japan with patients registered from April 2006 to June 2015. We evaluated the catheter sizes used and compared the success rate, thrombolysis in myocardial infarction (TIMI) flow, blush score, and complications between the rich-thrombus (RT) group [acute coronary syndrome (ACS) and saphenous vein graft (SVG)] and the poor-thrombus (PT) group [in-stent restenosis (ISR), chronic total occlusion (CTO), calcification, and long or bifurcation (L&B) lesions]. Of the 328 patients, 6 (1.8%) were treated for an SVG, 175 (53.4%) were treated for ACS, 18 (5.5%) for CTO, 106 (32.4%) for ISR, 8 (2.4%) for calcification, and 15 for L&B lesions (4.6%). A 1.7-mm (concentric)-diameter ELCA catheter was used most frequently (59.4%). High success rates were achieved in both the RT and PT groups, but the TIMI flow grade and blush score were significantly lower and the complications rate was significantly higher in the RT group (n=181).In Japan, the major indications for ELCA have been ACS and ISR. ELCA can provide a safe and effective treatment even for RT lesions.


Omori K.,Bellland General Hospital | Yagi T.,Bellland General Hospital
Journal of the Japan Diabetes Society | Year: 2014

The aim of this study was to evaluate the influence of withdrawing pioglitazone (Pio) on glycemic control and identify indicators of deterioration of the HbAlc level following Pio withdrawal in 159 type 2 diabetes subjects. The HbAlc levels were retrospectively evaluated 12 months after withdrawal. There were no restrictions on changes in other antidiabetic drugs, the use of which increased in 140 patients (88.1 %) during the observation period. Consequently, the HbAlc levels were found to be elevated by more than 1.5 % following the withdrawal of Pio in 43 patients (27.0 %) at 5.81 ± 2.91 months on average, a rate that was significantly higher than that observed in the control group (27.0 % vs 6.9 %, p< 0.000005). Furthermore, in the logistic regression analysis, a female sex and the use of three or more oral antidiabetic drugs were selected as explanatory variables for deterioration of the HbAlc level following the withdrawal of Pio. Our results indicated a marked increase in HbAlc in approximately 30 % of the subjects who discontinued Pio, with an interval of approximately six months for deterioration. We therefore suggest that withdrawing Pio therapy is likely to result in unfavorable effects on glycemic control, especially in female patients receiving multidrug therapy.


Mizumura N.,Bellland General Hospital | Demura K.,Bellland General Hospital | Kawasaki M.,Bellland General Hospital | Okumura S.,Bellland General Hospital | And 5 more authors.
Internal Medicine | Year: 2015

A 76-year-old previously healthy Japanese man experienced severe diarrhea (8,000 mL per day) after undergoing laparotomy for small bowel obstruction and was diagnosed with Clostridium difficile infection. Although he developed a maculopapular rash secondary to the systemic absorption of enteral vancomycin (VCM), the patient was successfully treated with the continuous administration of VCM through a long intestinal tube placed in the terminal ileum. This method ensured the reliable delivery of VCM to the colon, while the continuous administration maintained high fecal levels of the drug. This treatment approach is an effective minimally invasive option for patients with severe diarrhea. © 2015 The Japanese Society of Internal Medicine.


Horiuchi T.,Bellland General Hospital | Noguchi T.,Bellland General Hospital | Kurita N.,Bellland General Hospital | Yamaguchi A.,Bellland General Hospital | And 3 more authors.
Japanese Journal of Anesthesiology | Year: 2016

We present two patients developing intraoperative massive bleeding and showed ischemic changes in the electrocardiogram and circulatory collapse accompanied by severe anemia owing to the delay of red blood cell concentrate transfusion. One patient underwent hepatectomy and the other pancreaticoduodenectomy. Their lowest hemoglobin concentration was around 2 g • dl-1, and they showed ischemic changes in the electrocardiogram and severe decreases in blood pressure. The former received compatible red blood cell concentrate and the latter received uncrossmatched same blood group red blood cell concentrate immediately, and their electrocardiogram and blood pressure quickly improved. To avoid life-threatening anemia emergency red blood cell concentrate transfusion including compatible different blood group transfusion should be applied for intraoperative massive bleeding.


PubMed | Bellland General Hospital
Type: Case Reports | Journal: Internal medicine (Tokyo, Japan) | Year: 2015

A 76-year-old previously healthy Japanese man experienced severe diarrhea (8,000 mL per day) after undergoing laparotomy for small bowel obstruction and was diagnosed with Clostridium difficile infection. Although he developed a maculopapular rash secondary to the systemic absorption of enteral vancomycin (VCM), the patient was successfully treated with the continuous administration of VCM through a long intestinal tube placed in the terminal ileum. This method ensured the reliable delivery of VCM to the colon, while the continuous administration maintained high fecal levels of the drug. This treatment approach is an effective minimally invasive option for patients with severe diarrhea.


PubMed | BellLand General Hospital
Type: Case Reports | Journal: Nihon Hinyokika Gakkai zasshi. The japanese journal of urology | Year: 2010

A 64-year-old man visited our hospital presenting with macroscopic hematuria. Right hydronephrosis and hypertrophy of the prostate were shown by DIP and MRI respectively. A small papillary tumor at the prostatic urethra was found by cystourethroscopy. Then, we performed transurethral resection of the tumor and trans-perineal needle biopsy of the prostate, and diagnosed him as primary urothelial carcinoma of the prostate. Following neo-adjuvant chemotherapy(MVAC), the patient was treated with radical cystoprostatectomy. The histopathological examination showed urothelial carcinoma with concomitant sarcomatous transformation. Six months after the surgery, he had a recurrence of the tumor in the pelvic cavity. He was treated with the second-line chemotherapy using paclitaxel and gemcitabin combined with the radiation therapy, resulting in the disappearance of the tumor. No evidence of the recurrence has been observed for 3 years.


PubMed | Osaka Rosai Hospital and Bellland General Hospital
Type: Journal Article | Journal: Global spine journal | Year: 2015

Study DesignCase report. ObjectiveTo present two cases of neurogenic shock that occurred immediately following posterior lumbar interbody fusion (PLIF) and that appeared to have been caused by the vasovagal reflex after dural injury and incarceration of the cauda equina. Case ReportWe present two cases of neurogenic shock that occurred immediately following PLIF. One patient had bradycardia, and the other developed cardiac arrest just after closing the surgical incision and opening the drainage tube. Cardiopulmonary resuscitation was performed immediately, and the patients recovered successfully, but they showed severe motor loss after awakening. The results of laboratory data, chest X-ray, electrocardiogram, computed tomography, and echocardiography ruled out pulmonary embolism, hemorrhagic shock, and cardiogenic shock. Although the reasons for the postoperative shock were obscure, reoperation was performed to explore the cause of paralysis. At reoperation, a cerebrospinal fluid collection and the incarceration of multiple cauda equina rootlets through a small dural tear were observed. The incarcerated cauda equina rootlets were reduced, and the dural defect was closed. In both cases, the reoperation was uneventful. From the intraoperative findings at reoperation, it was thought that the pathology was neurogenic shock via the vasovagal reflex. ConclusionIncarceration of multiple cauda equina rootlets following the accidental dural tear by suction drainage caused a sudden decrease of cerebrospinal fluid pressure and traction of the cauda equina, which may have led to the vasovagal reflex.


PubMed | Bellland General Hospital
Type: Clinical Trial | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2012

This study compared the efficacy and safety of a 3-day-type transdermal fentanyl patch conversion by the rapid titration method to short-acting oral oxycodone for cancer pain.We evaluated seven hospitalized cancer patients who had moderate to severe cancer pain.Pain intensity was rated using an 11-point(0-10)numerical rating scale(NRS).All 7 patients initially reported their pain intensity at rest as NRS4 during treatment by Non-Steroidal Anti-Inflammatory Drugs(NSAIDs).Short - acting oral oxycodone(OxiNorm)5 mg was administered to all patients.One hour after short-acting oral oxycodone was administered, pain assessment was carried out using NRS by the author.Short -acting oral oxycodone was administered four times a day periodically, and as a rescue dose.If the total daily dose of short-acting oral oxycodone was stable for 2 days, we switched to the 3-day-type transdermal fentanyl patch.The optimal dosage of the 3-day-type transdermal fentanyl patch was determined by titration of short-acting oral oxycodone.All 7 patients reported mild levels(NRS2)of cancer pain for 2 days.No serious side effects were reported.The 3-day-type transdermal fentanyl patch conversion by the rapid titration method with short-acting oral oxycodone can be accomplished safely and effectively for patients with moderate cancer pain.


Yamazaki K.,Bellland General Hospital | Fujio N.,Bellland General Hospital | Ishikawa N.,Bellland General Hospital | Watanabe H.,Bellland General Hospital | Kameyama M.,Bellland General Hospital
Japanese Journal of Cancer and Chemotherapy | Year: 2012

This study compared the efficacy and safety of a 3-day-type transdermal fentanyl patch conversion by the rapid titration method to short-acting oral oxycodone for cancer pain. We evaluated seven hospitalized cancer patients who had moderate to severe cancer pain. Pain intensity was rated using an 11-point (0-10) numerical rating scale (NRS). All 7 patients initially reported their pain intensity at rest as NRS≧4 during treatment by Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). Short-acting oral oxycodone (OxiNorm®) 5 mg was administered to all patients. One hour after short-acting oral oxycodone was administered, pain assessment was carried out using NRS by the author. Short-acting oral oxycodone was administered four times a day periodically, and as a rescue dose. If the total daily dose of short-acting oral oxycodone was stable for 2 days, we switched to the 3-day-type transdermal fentanyl patch. The optimal dosage of the 3-day-type transdermal fentanyl patch was determined by titration of short-acting oral oxycodone. All 7 patients reported mild levels (NRS≦2) of cancer pain for 2 days. No serious side effects were reported. The 3-day-type transdermal fentanyl patch conversion by the rapid titration method with short-acting oral oxycodone can be accomplished safely and effectively for patients with moderate cancer pain.

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