Juzenkai Hospital

Nagasaki-shi, Japan

Juzenkai Hospital

Nagasaki-shi, Japan
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Tazawa R.,Niigata University | Inoue Y.,National Hospital Organization NHO | Arai T.,National Hospital Organization NHO | Takada T.,Niigata University | And 20 more authors.
Chest | Year: 2014

Background: Treatment of autoimmune pulmonary alveolar proteinosis (aPAP) by subcutaneous injection or inhaled therapy of granulocyte-macrophage colony-stimulating factor (GM-CSF) has been demonstrated to be safe and efficacious in several reports. However, some reports of subcutaneous injection described transient benefit in most instances. The durability of response to inhaled GM-CSF therapy is not well characterized. Methods: To elucidate the risk factors for recurrence of aPAP after GM-CSF inhalation, 35 patients were followed up, monitoring for the use of any additional PAP therapies and disease severity score every 6 months. Physiologic, serologic, and radiologic features of the patients were analyzed for the findings of 30-month observation after the end of inhalation therapy. Results: During the observation, 23 patients remained free from additional treatments, and twelve patients required additional treatments. There were no significant differences in age, sex, symptoms, oxygenation indexes, or anti-GM-CSF antibody levels at the beginning of treatment between the two groups. Baseline vital capacity (% predicted, %VC) were higher among those who required additional treatment ( P < .01). Those patients not requiring additional treatment maintained the improved disease severity score initially achieved. A significant difference in the time to additional treatment between the high %VC group (%VC ≥ 80.5) and the low %VC group was seen by a Kaplan-Meier analysis and a log-rank test ( P < .0005). Conclusions: These results demonstrate that inhaled GM-CSF therapy sustained remission of aPAP in more than one-half of cases, and baseline %VC might be a prognostic factor for disease recurrence. © 2014 American College of Chest Physicians.


PubMed | Kameda Medical Center, Juzenkai Hospital, Chikamori Hospital, Ebetsu City Hospital and Nagasaki University
Type: Journal Article | Journal: PloS one | Year: 2015

The increasing burden of pneumonia in adults is an emerging health issue in the era of global population aging. This study was conducted to elucidate the burden of community-onset pneumonia (COP) and its etiologic fractions in Japan, the worlds most aged society.A multicenter prospective surveillance for COP was conducted from September 2011 to January 2013 in Japan. All pneumonia patients aged 15 years, including those with community-acquired pneumonia (CAP) and health care-associated pneumonia (HCAP), were enrolled at four community hospitals on four major islands. The COP burden was estimated based on the surveillance data and national statistics.A total of 1,772 COP episodes out of 932,080 hospital visits were enrolled during the surveillance. The estimated overall incidence rates of adult COP, hospitalization, and in-hospital death were 16.9 (95% confidence interval, 13.6 to 20.9), 5.3 (4.5 to 6.2), and 0.7 (0.6 to 0.8) per 1,000 person-years (PY), respectively. The incidence rates sharply increased with age; the incidence in people aged 85 years was 10-fold higher than that in people aged 15-64 years. The estimated annual number of adult COP cases in the entire Japanese population was 1,880,000, and 69.4% were aged 65 years. Aspiration-associated pneumonia (630,000) was the leading etiologic category, followed by Streptococcus pneumoniae-associated pneumonia (530,000), Haemophilus influenzae-associated pneumonia (420,000), and respiratory virus-associated pneumonia (420,000), including influenza-associated pneumonia (30,000).A substantial portion of the COP burden occurs among elderly members of the Japanese adult population. In addition to the introduction of effective vaccines for S. pneumoniae and influenza, multidimensional approaches are needed to reduce the pneumonia burden in an aging society.


Kondo A.,Chubu University | Zierler B.K.,University of Washington | Isokawa Y.,Juzenkai Hospital | Hagino H.,Tottori University | And 2 more authors.
Disability and Rehabilitation | Year: 2010

Purpose. To examine whether the length of stay (LOS) after hip fracture surgery was related to mortality after discharge by comparing between hospitals in Japan and the United States (US). Method. This is a retrospective observational study of three hospitals in Japan and two in the Pacific Northwest in the US. The median follow-up day was 276 days after surgery. The participants were 65 years or older who had experienced hip fracture and were admitted to one of the study hospitals for surgery. Results. The median LOS after surgery was 34 days in Japan and 5 days in the US. The survival rate was 89.5% in Japan and 77.2% in the US among patients who could be followed-up. In the Cox regression, every 10 day increase in the LOS after surgery was associated with a 26% reduction in the risk of mortality (Hazard ratio=0.744, p=0.014) after adjusting for LOS before surgery, patients' basic characteristics, number of complications and country. Conclusions. Shorter lengths of stay after surgery did not predict better survival across the two countries. Larger longitudinal or randomized studies that determine the effects of LOS after surgery on mortality are necessary. © 2010 Informa UK Ltd.


Okunaga T.,Nagasaki Rosai Hospital | Izumo T.,Nagasaki Rosai Hospital | Yoshioka T.,Nagasaki Rosai Hospital | Shimizu T.,Juzenkai Hospital | And 2 more authors.
Neurological Surgery | Year: 2010

This report presents a case of a transorbital penetrating brain injury caused by a metal rod. A 47-year-old male injured his left lower eyelid with no witness during working hours. The two days later, he presented with a right hand tremor and abnormal behavior, and was admitted to the hospital. A CT showed a bone fracture of the left orbital roof and a low-density lesion of the left frontal lobe. The initial diagnosis was a cerebral contusion due to a blow-out fracture. However, sagittal MR images on the tenth day in the hospital demonstrated a penetrating tract that was running linearly from the left orbital roof to the left caudate head. Therefore, the final diagnosis was a transorbital penetrating brain injury. This case had no severe complications in spite of the delayed diagnosis. Careful examinations are thus required in order to make a correct diagnosis at the first examination, because a transorbital penetrating brain injury might initially present as a slight wound with no neurological signs.


Hamaue Y.,Nagasaki University | Hamaue Y.,Juzenkai Hospital | Nakano J.,Nagasaki University | Sekino Y.,Nagasaki University | And 5 more authors.
Journal of Physiological Sciences | Year: 2013

This study examined mechanical and thermal hypersensitivity in the rat hind paw during cast immobilization of the hind limbs for 4 or 8 weeks and following cast removal. Blood flow, skin temperature, and volume of the rat hind paw were assessed in order to determine peripheral circulation of the hind limbs. Sensitization was analyzed by measuring the expression of the calcitonin gene-related peptide (CGRP) in the spinal dorsal horn following cast immobilization. Two weeks post immobilization, mechanical and thermal sensitivities increased significantly in all rats; however, peripheral circulation was not affected by immobilization. Cast immobilization for 8 weeks induced more serious hypersensitivity compared to cast immobilization for 4 weeks. Moreover, CGRP expression in the deeper lamina layer of the spinal dorsal horn increased in the rats immobilized for 8 weeks but not in those immobilized for 4 weeks. These findings suggest that immobilization-induced hypersensitivity develops during the immobilization period without affecting peripheral circulation. Our results also highlight the possibility that prolonged immobilization induces central sensitization in the spinal cord. © 2013 The Physiological Society of Japan and Springer Japan.


Chuganji S.,Nagasaki University | Nakano J.,Nagasaki University | Sekino Y.,Nagasaki University | Hamaue Y.,Nagasaki University | And 3 more authors.
Neuroscience Letters | Year: 2015

Cast immobilization of limbs causes hyperalgesia, which is a decline of the threshold of mechanical and thermal mechanical stimuli. The immobilization-induced hyperalgesia (IIH) can disturb rehabilitation and activities of daily living in patients with orthopedic disorders. However, it is unclear what therapeutic and preventive approaches can be used to alleviate IIH. Exercise that activates the descending pain modulatory system may be effective for IIH. The purpose of this study was to investigate the effects of treadmill exercise during the immobilization period, using the non-immobilized limbs, on IIH. Thirty-six 8-week-old Wistar rats were randomly divided into (1) control, (2) immobilization (Im), and (3) immobilization and treadmill exercise (Im. +. Ex) groups. In the Im and Im. +. Ex groups, the right ankle joints of each rat were immobilized in full plantar flexion with a plaster cast for an 8-week period. In the Im. +. Ex group, treadmill exercise (15. m/min, 30. min/day, 5 days/week) was administered during the immobilization period while the right hindlimb was kept immobilized. Mechanical hyperalgesia was measured using von Frey filaments every week. To investigate possible activation of the descending pain modulatory system, beta-endorphin expression levels in hypothalamus and midbrain periaqueductal gray were analyzed. Although IIH clearly occurred in the Im group, the hyperalgesia was partially but significantly reduced in the Im. +. Ex group. Beta-endorphin, which is one of the endogenous opioids, was selectively increased in the hypothalamus and midbrain periaqueductal gray of the Im. +. Ex group. Our data suggest that treadmill running using the non-immobilized limbs reduces the amount of hyperalgesia induced in the immobilized limb even if it is not freed. This ameliorating effect might be due to the descending pain modulatory system being activated by upregulation of beta-endorphin in the brain. © 2014 Elsevier Ireland Ltd.


Oku T.,Nagasaki University | Tanabe K.,Nagasaki University | Ogawa S.,Juzenkai hospital | Sadamori N.,Nagasaki University | Nakamura S.,Nagasaki University
Clinical and Experimental Gastroenterology | Year: 2011

Background: The purpose of this study was to clarify whether it is possible to extrapolate results from studies of the hydrolyzing activity of disaccharidases from rats to humans. Materials and methods: We measured disaccharidase activity in humans and rats using identical preparation and assay methods, and investigated the similarity in hydrolyzing activity. Small intestinal samples without malignancy were donated by five patients who had undergone bladder tumor surgery, and homogenates were prepared to measure disaccharidase activity. Adult rat homogenates were prepared using small intestine. Results: Maltase activity was the highest among the five disaccharidases, followed by sucrase and then palatinase in humans and rats. Trehalase activity was slightly lower than that of palatinase in humans and was similar to that of sucrase in rats. Lactase activity was the lowest in humans, but was similar to that of palatinase in rats. Thus, the hydrolyzing activity of five disaccharidases was generally similar in humans and rats. The relative activity of sucrose and palatinase versus maltase was generally similar between humans and rats. The ratio of rat to human hydrolyzing activity of maltase, sucrase, and palatinase was 1.9-3.1, but this was not a significant difference. Leaf extract from Morus alba strongly inhibited the activity of maltase, sucrase, and palatinase, but not trehalase and lactase, and the degree of inhibition was similar in humans and rats. L-arabinose mildly inhibited sucrase activity, but hardly inhibited the activity of maltase, palatinase, trehalase and lactase in humans and rats. The digestibility of 1-kestose, galactosylsucrose, and panose by small intestinal enzymes was very similar between humans and rats. Conclusion: These results demonstrate that the digestibility of newly developed saccharide materials evaluated by rat small intestinal enzymes can substitute for evaluation using human enzymes. © 2011 Oku et al.


Hamaue Y.,Nagasaki University | Hamaue Y.,Juzenkai Hospital | Nakano J.,Nagasaki University | Sekino Y.,Nagasaki University | And 5 more authors.
Physical Therapy | Year: 2014

Background. Cast immobilization induces mechanical hypersensitivity, which disturbs rehabilitation. Although vibration therapy can reduce various types of pain, whether vibration reduces immobilization-induced hypersensitivity remains unclear. Objective. The purpose of this study was to investigate the preventive and therapeutic effects of vibration therapy on immobilization-induced hypersensitivity. Design. The experimental design of the study involved conducting behavioral, histological, and immunohistochemical studies in model rats. Methods. Thirty-five Wistar rats (8 weeks old, all male) were used. The right ankle joints of 30 rats were immobilized by plaster cast for 8 weeks, and 5 rats were used as controls. The immobilized rats were divided randomly into the following 3 groups: (1) immobilization-only group (Im, n = 10); (2) vibration therapy group 1, for which vibration therapy was initiated immediately after the onset of immobilization (Im + Vib1, n = 10); and (3) vibration therapy group 2, for which vibration therapy was initiated 4 weeks after the onset of immobilization (Im  + Vib2, n = 10). Vibration was applied to the hind paw. The mechanical hypersensitivity and epidermal thickness of the hind paw skin were measured. To investigate central sensitization, calcitonin gene-related peptide (CGRP) expression in the spinal cord and dorsal root ganglion (DRG) was analyzed. Results. Immobilization-induced hypersensitivity was inhibited in the Im + Vib1 group but not in the Im + Vib2 group. Central sensitization, which was indicated by increases in CGRP expression in the spinal cord and the size of the area of CGRPpositive neurons in the DRG, was inhibited in only the Im + Vib1 group. Epidermal thickness was not affected by vibration stimulation. Limitations. A limitation of this study is that the results were limited to an animal model and cannot be generalized to humans. Conclusions. The data suggest that initiation of vibration therapy in the early phase of immobilization may inhibit the development of immobilization-induced hypersensitivity. © 2014, American Physical Therapy Association.


Ishizaka S.,Juzenkai Hospital | Shimizu T.,Juzenkai Hospital | Ryu N.,Juzenkai Hospital
Brain Injury | Year: 2014

Background: Although Duret haemorrhage of the brainstem caused by descending transtentorial herniation is considered fatal, a few cases have been reported to have good outcome. Moreover, most patients with Duret haemorrhage have severe primary brain injury and the potential outcome of those with mild primary brain injury remains unknown. Case report: This study reports the case of a patient presenting with Duret haemorrhage caused by an idiopathic subdural haematoma who demonstrated dramatic recovery. The patient presented with a low Glasgow Coma Scale score and bilateral oculomotor palsy on admission. Pre-operative CT revealed a large subdural haematoma and Duret haemorrhage of the mid-brain. The subdural haematoma was immediately evacuated under local anaesthesia and the patient demonstrated dramatic post-operative recovery, with no residual quadriparesis and minimal cognitive dysfunction. Interestingly, only bilateral oculomotor palsy persisted. This indicates that Duret haemorrhage restricted to the central portion of the mid-brain without severe primary brain injury has good prognosis. Conclusion: Therefore, patients with Duret haemorrhage of the mid-brain caused by simple subdural haematoma presenting with bilateral oculomotor palsy, including bilateral pupillary dilation, may not always have a poor prognosis. © 2014 Informa UK Ltd.


Although Duret haemorrhage of the brainstem caused by descending transtentorial herniation is considered fatal, a few cases have been reported to have good outcome. Moreover, most patients with Duret haemorrhage have severe primary brain injury and the potential outcome of those with mild primary brain injury remains unknown.This study reports the case of a patient presenting with Duret haemorrhage caused by an idiopathic subdural haematoma who demonstrated dramatic recovery. The patient presented with a low Glasgow Coma Scale score and bilateral oculomotor palsy on admission. Pre-operative CT revealed a large subdural haematoma and Duret haemorrhage of the mid-brain. The subdural haematoma was immediately evacuated under local anaesthesia and the patient demonstrated dramatic post-operative recovery, with no residual quadriparesis and minimal cognitive dysfunction. Interestingly, only bilateral oculomotor palsy persisted. This indicates that Duret haemorrhage restricted to the central portion of the mid-brain without severe primary brain injury has good prognosis.Therefore, patients with Duret haemorrhage of the mid-brain caused by simple subdural haematoma presenting with bilateral oculomotor palsy, including bilateral pupillary dilation, may not always have a poor prognosis.

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