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Tsuji S.,Hoshigaoka Koseinenkin Hospital | Tomita T.,Osaka University | Fujii M.,Garacia Hospital | Laskin R.S.,Cornell University | And 2 more authors.
Journal of Arthroplasty | Year: 2010

With recent technical advancements, the number of operative manipulations in the knee joint by minimally invasive surgery-total knee arthroplasty (MIS-TKA) is now considered to be the same as that using standard TKA (S-TKA). The question still remains, however, if MIS-TKA improves recovery compared to S-TKA. We compared MIS-TKA and S-TKA patients' physical activity as measured by an accelerometer. Physical activity expressed as cumulative acceleration was significantly higher in the MIS-TKA than in the S-TKA group on postoperative days (POD1, 2, 3, 4, 5, 10, 11) (P < .05). The recovery time, defined as the number of days required to achieve cumulative acceleration of 80% of the preoperative level, was significantly shorter (P < .05) in the MIS-TKA (3.0 ± 3.3 days) group than in the S-TKA (7.0 ± 3.5 days) group. Minimally invasive surgery-total knee arthroplasty appears to allow an earlier recovery after the operation than S-TKA. Less invasion to muscle during the surgery appears to contribute to shorter convalescence. © 2010 Elsevier Inc.


Shimada K.,Osaka Koseinenkin Hospital | Tanaka H.,Osaka Koseinenkin Hospital | Matsumoto T.,Kurashiki Central Hospital | Miyake J.,Osaka University | And 3 more authors.
Journal of Bone and Joint Surgery - Series A | Year: 2012

Background: There is a need to clarify the usefulness of and problems associated with cylindrical costal osteochondral autograft for reconstruction of large defects of the capitellum due to osteochondritis dissecans. Methods: Twenty-six patients with advanced osteochondritis dissecans of the humeral capitellum were treated with use of cylindrical costal osteochondral autograft. All were males with elbow pain and full-thickness articular cartilage lesions of ≥15 mm in diameter. Clinical, radiographic, and magnetic resonance imaging outcomes were evaluated at a mean follow-up of thirty-six months (range, twenty-four to fifty-one months). Results: All patients had rapid functional improvement after treatment with costal osteochondral autograft and returned to their former activities, including sports. Five patients needed additional minor surgical procedures, including screw removal, loose body removal, and shaving of protruded articular cartilage. Mean elbow function, assessed with use of the clinical rating system of Timmerman and Andrews, was 111 points preoperatively and improved to 180 points at the time of follow-up and to 190 points after the five patients underwent the additional operations. Mean elbow motion was 126° of flexion with 16° of extension loss preoperatively and improved to 133° of flexion with 3° of extension loss at the time of follow-up. Osseous union of the graft on radiographs was obtained within three months in all patients. Revascularization of the graft depicted on T1-weighted magnetic resonance imaging and congruity of the reconstructed articular surface depicted on T2-weighted or short tau inversion recovery imaging were assessed at twelve and twenty-four months postoperatively. Functional recovery was good, and all patients were satisfied with the final outcomes. Conclusions: Cylindrical costal osteochondral autograft was useful for the treatment of advanced osteochondritis dissecans of the humeral capitellum. Functional recovery was rapid after surgery. Additional operations were performed for five of the twenty-six patients, whereas the remaining patients showed essentially full recovery within a year. All patients were satisfied with the results at the time of short-term follow-up. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2012 by The Journal of Bone and Joint Surgery, Incorporated.


Shimizu K.,Osaka University | Ogura H.,Osaka University | Asahara T.,Yakult Central Institute for Microbiological Research | Nomoto K.,Yakult Central Institute for Microbiological Research | And 6 more authors.
Digestive Diseases and Sciences | Year: 2013

The gut is an important target organ for stress caused by severe insults such as sepsis, trauma, burn, shock, bleeding and infection. Severe insult to the gut is considered to have an important role in promoting infectious complications and multiple organ dysfunction syndrome. These are sequelae of interactions between deteriorated intestinal epithelium, the immune system and commensal bacteria. The gut is the "motor" of multiple organ failure, and now it is recognized that gut dysfunction is a causative factor in disease progression. The gut flora and environment are significantly altered in critically ill patients, and the number of obligate anaerobes is associated with prognosis. Synbiotic therapy is a combination of probiotics and prebiotics. Probiotic, prebiotic and synbiotic treatment has been shown to be a promising therapy to maintain and repair the gut microbiota and gut environment. In the critically ill, such as major abdominal surgery, trauma and ICU patients, synbiotic therapy has been shown to significantly reduce septic complications. Further basic and clinical research would clarify the underlying mechanisms of the therapeutic effect of probiotic/synbiotic treatment and define the appropriate conditions for use. © 2012 The Author(s).


Tsuji S.,Hoshigaoka Koseinenkin Hospital | Tomita T.,Osaka University | Inaoka M.,Nissay Hospital | Higashiyama M.,Nissay Hospital
Clinical Orthopaedics and Related Research | Year: 2010

Abnormal reactions accompanied by bone formation in the osteoarticular region induced by long-term administration of etretinate have been reported. We treated a patient who received continuous treatment of psoriatic erythroderma with etretinate for 7 years, and who had an osseous bridge that extended across the acetabulum over the femur on both sides. The patient experienced a major gait disturbance and eventually was unable to walk. Functional gait was restored by resecting the ossified regions and radiotherapy. Histologic sections of the ossified lesions showed enchondral ossification in the ligament attachment site in the joint margin, with advancing ossification along the articular capsule; the pattern was similar to that in diffuse idiopathic skeletal hyperostosis. This is the first report of an osseous bridge associated with long-term administration of etretinate extending across the acetabulum over the femur on both sides. © 2009 The Association of Bone and Joint Surgeons ®.


Iwai T.,Hoshigaoka Koseinenkin Hospital | Hamada M.,Hoshigaoka Koseinenkin Hospital | Miyama T.,Hoshigaoka Koseinenkin Hospital | Shino K.,Osaka Prefecture University
Sports Medicine, Arthroscopy, Rehabilitation, Therapy and Technology | Year: 2012

Hoffa fracture, an isolated coronal plane fracture of the posterior aspect of the femoral condyle, is known as an unstable, intra-articular fracture, and therefore, operative treatment is recommended. However, insufficient open reduction or failure of fixation may lead to malunion. We performed intra-articular corrective osteotomy for a malunited Hoffa fracture in a 31-year-old man and obtained good functional and radiographic results. This report suggests that intra-articular corrective osteotomy for malunited Hoffa fracture offers a good outcome and should be considered as salvage treatment. © 2012 Iwai et al.; licensee BioMed Central Ltd.


Tanaka M.,Osaka University | Tanaka M.,Hoshigaoka Koseinenkin Hospital | Sakaguchi M.,Osaka University | Miwa K.,Osaka University | And 5 more authors.
Arteriosclerosis, Thrombosis, and Vascular Biology | Year: 2013

Objective-Basilar arterial (BA) dolichoectasia is associated with cerebral small-vessel disease and stroke. However, the association between moderate dilation of the BA and cerebral small-vessel disease or subsequent cardiovascular events remains unclear. This study aims to clarify the factors related to BA diameter and to clarify whether the BA diameter is an independent predictor of cardiovascular events. Approach and Results-The study subjects comprised 493 outpatients with atherosclerotic risk factors. BA diameter, lacunar infarct, severity of deep white matter hyperintensities, and intracranial steno-occlusive lesions were assessed with MRI and magnetic resonance angiography. Then, we prospectively evaluated the association between BA diameter and cardiovascular events. The BA diameter ranged from 1.1 to 5.2 mm, and only 0.8% of the patients had dolichoectasia. Male sex, the presence of lacunar infarcts, the severity of deep white matter hyperintensities, the fetal-type variation of the circle of Willis, and intracranial steno-occlusive lesions were independently associated with BA diameter. In the mean follow-up of 6.0 years, 91 patients developed cardiovascular events. BA diameter was independently associated with total cardiovascular events after adjusting for age, sex, and conventional risk factors (hazard ratio, 1.55 per 1 mm increase in BA diameter; P=0.009). Conclusions-Increased BA diameter within the normal range is related to both large-vessel disease and cerebral small-vessel disease, and it could be a new predictor of cardiovascular events. © 2013 American Heart Association, Inc.


Shimono T.,Hoshigaoka Koseinenkin Hospital
Nihon Hoshasen Gijutsu Gakkai zasshi | Year: 2012

Ionization chamber measurements in radiation therapy should be repeatedly performed until a stable reading is obtained. Ionization chambers exhibit a response which depends on time elapsed since the previous irradiation. In this study, we investigated the response of a set of two Farmer-style, one Plane parallel, and seven small ionization chambers, which are exposed to 4, 6, 10, and 14 MV. The results show that Farmer-style and Plane parallel ionization chambers settle quickly within 9-20 min. On the other hand, small ionization chambers exhibit settling times of 12-33 min for 6, 10, and 14 MV. It will take longer for a settling time of 4 MV. The settling time showed time dependent irradiation. The first reading was up to 0.76% lower in the Farmer-style and Plane parallel ionization chambers. The small ionization chambers had a 2.60% lower first reading and more gradual response in reaching a stable reading. In this study, individual ionization chambers can vary significantly in their settling behavior. Variation of the responses on ionization chambers were confirmed not only when radiation was not used for a week but also when it was halted for a month. Pre-irradiation of small ionization chambers is clearly warranted for eliminating inadvertent error in the calibration of radiation beams.


Our A.,Hoshigaoka Koseinenkin Hospital
Nippon Ganka Gakkai zasshi | Year: 2010

PURPOSE: To investigate risk factors for visual impairment following bleb-related infection after trabeculectomy with mitomycin C. METHODS: We retrospectively reviewed 31 cases of bleb-related infection at Osaka Koseinenkin hospital from 2004 to 2007. RESULTS: Twelve cases of blebitis and 19 cases of bleb-related endophthalmitis were studied. According to the stage of infection, each patient was continued to be treated following a previously decided treatment strategy. Fifteen patients underwent pars plana vitrctomy. Two patients with blebitis progressed to endopthalmitis. Visual acuity in seven eyes (22.6%) decreased by two or more lines following infection. Risk factors for visual impairments following bleb-related infections were recurrence of infection (p = 0.022), negative Seidel tests (p = 0.0056), aphakia (p = 0.045), avitreous (p = 0.00070), positive Streptococcus species (p = 0.029), and prolonged inflammation (p = 0.014). CONCLUSIONS: Recurrence of infection, negative Seidel tests, aphakia and avitreous are risk factors for visual impairment following bleb-related infection after trabeculectomy.


Iwai T.,Hoshigaoka Koseinenkin Hospital
International orthopaedics | Year: 2013

Tranexamic acid (TXA) reduces blood loss in patients undergoing total knee arthroplasty (TKA). However, few studies have reported the optimum timing and dosage for administration of TXA. The purpose of this study was to evaluate the effect of repeat-dose TXA on blood loss during TKA and the necessity of autologous blood donation or postoperative autotransfusion. We enrolled 78 patients with primary osteoarthritis undergoing cemented TKAs. Consecutive patients were divided into three groups, as follows: control group (n = 31), single-TXA group (n = 21) in whom TXA (1,000 mg) was intravenously administered 10 min before deflation of the tourniquet, and twice-TXA group (n = 26) in whom TXA (1,000 mg) was intravenously administered 10 min before deflation of the tourniquet and 3 h after the operation. We measured the volume of drained blood after the operation. Haemoglobin (Hb) levels were measured at days 1, 4 and 7 postoperation. Venous thromboembolic events (VTE) were screened using compression ultrasonography at enrollment and 1 and 7 days after operation. The mean volume of drained blood after the operation was lower in the twice-TXA group than in the single-TXA (p < 0.001) and control (p < 0.0001) groups. No significant differences were observed in the incidence of VTE between these groups. Administration of TXA twice reduced postoperative blood loss after TKA, and TXA was not associated with the risk of deep-vein thrombosis (DVT) or pulmonary embolism (PE). Further, administration of TXA twice may eliminate the need for blood transfusion during TKA.


Wada E.,Hoshigaoka Koseinenkin Hospital | Kawai H.,Hoshigaoka Koseinenkin Hospital
Spinal Cord | Year: 2010

Study design: Case report. Objectives: To report the late onset of cervical myelopathy secondary to fibrous scar tissue formation around an epidural electrode implanted for spinal cord stimulation (SCS). Setting: Department of Orthopaedic Surgery, Hoshigaoka Koseinenkin Hospital, Osaka, Japan.Method and results:A 49-year-old man who had an electrode implanted for SCS 5 years ago was referred to our department on 2 March 2005, complaining of difficulty using chopsticks and walking. A computed tomography scan with myelography revealed severe spinal cord compression around the epidural electrode. Surgical removal of the electrode was not effective. Removal of fibrous scar tissue during a second surgery significantly improved his neurological symptoms. Conclusion: Late onset cervical myelopathy secondary to fibrous scar tissue formation around the epidural electrode should be considered a possible event associated with SCS therapy. © 2010 International Spinal Cord Society All rights reserved.

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