Kamagaya General Hospital

Chiba, Japan

Kamagaya General Hospital

Chiba, Japan
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Nagura T.,Keio University | Niki Y.,Keio University | Harato K.,Keio University | Mochizuki T.,Kamagaya General Hospital | Kiriyama Y.,Kogakuin University
Knee | Year: 2016

Background: Analysis of dynamic knee loading during gait is essential to prevent mechanical failures following total knee arthroplasty. External knee adduction moment during gait is the primary factor producing medial joint reaction force, and an increase in the moment is directly related to an increase in the medial compartment load on the knee. Methods: Knee adduction moment during gait in 39 knees of 32 female patients following a posterior stabilized knee replacement with a single surgeon was evaluated at 1.3. months following surgery. A cut-off moment was determined as mean + 1 standard deviation (SD) of the moment from 10 healthy subjects, and patients' knees were divided into high- and normal-moment groups. Significant differences in clinical assessments and gait parameters between the two groups were assessed. Results: Based on the cut-off moment, 23 knees were grouped into normal knees and 16 knees were grouped into high-moment knees. High-moment knees showed identical femorotibial angles and knee society scores but had greater toe-out angles and medially directed ground reaction forces compared to normal-moment knees. High-moment knees showed strong correlations between peak moment and knee adduction angle, and frontal plain moment arm. Conclusions: The clinical significance of a high knee adduction moment following total knee arthroplasty remains unclear, but dynamic frontal alignment during gait is one of the key factors for residual high-moment knees following surgery. © 2016 Elsevier B.V.

Kaida S.,Kamagaya General Hospital | Imai Y.,Health Science University | Ohashi K.,Health Science University | Kitagawa A.,Shigakkan University
Cell Biochemistry and Function | Year: 2013

We examined whether water-immersion restraint stress (WIRS) disrupts nonenzymatic antioxidant defense systems through ascorbic acid depletion in the adrenal gland of rats. Rats were exposed to WIRS for 0.5, 1.5, 3 or 6h. WIRS increased serum adrenocorticotropic hormone, corticosterone and glucose concentrations and adrenal corticosterone content at each time point. WIRS increased adrenal lipid peroxide content at 3 and 6h, and the increase was twofold higher than the unstressed level at 6h. WIRS decreased adrenal ascorbic acid content at each time point, and the decrease reached one-third of the unstressed level at 6h. WIRS increased adrenal reduced glutathione content at 0.5 and 6h but reduced that content to half of the unstressed level at 6h. WIRS increased adrenal α-tocopherol content at 1.5h but returned that content to the unstressed level thereafter. When rats with 6h of WIRS was orally preadministered with l-ascorbic acid (250mg/kg), WIRS-induced changes in adrenal lipid peroxide, ascorbic acid and reduced glutathione contents were attenuated without any change in stress response. These results indicate that WIRS disrupts nonenzymatic antioxidant defense systems through rapid and continuous ascorbic acid depletion in the adrenal gland of rats. © 2012 John Wiley & Sons, Ltd.

Fujita K.,Tokushima University | Yuasa T.,Kamagaya General Hospital | Takahashi Y.,Shizuoka Institute of Epilepsy and Neurological Disorders | Tanaka K.,Kanazawa Medical University | And 7 more authors.
Journal of Neuroimmunology | Year: 2012

Psychiatric symptom can be a prominent feature early in Creutzfeldt-Jakob disease (CJD), which is also common in autoantibody-mediated limbic encephalitis. We hypothesized that anti-neuronal autoantibodies, especially those against N-methyl-D-aspartate glutamate receptors (NMDAR), can also be associated with CJD. Thirteen patients with CJD and 13 patients with limbic encephalitis were enrolled. Immunohistochemistry demonstrated that serum of CJD patients reacted with neuronal components of the rat hippocampus, indicating that those samples contained anti-neuronal antibodies. Enzyme-linked immunosorbent assay revealed that titers of antibodies against peptides of GluN2B subunit of NMDAR were significantly elevated in the serum and cerebrospinal fluid of CJD patients. © 2012 Elsevier B.V.

Shin W.-J.,University of Ulsan | Cheong Y.-S.,University of Ulsan | Yang H.-S.,University of Ulsan | Yang H.-S.,Kamagaya General Hospital | Nishiyama T.,University of Ulsan
European Journal of Anaesthesiology | Year: 2010

Background and objective The I-gel is a new single-use supraglottic airway device without an inflatable cuff. This study was designed to investigate the usefulness of the I-gel compared with the classic laryngeal mask airway (cLMA) and ProSeal laryngeal mask airway (pLMA) in anaesthetized, paralysed patients. Methods The American Society of Anesthesiologists physical status I-II patients (n=167) scheduled for orthopaedic surgery were included in this prospective study. General anaesthesia was achieved with intravenous infusion of propofol, remifentanil and rocuronium. The patients were randomly assigned to I-gel, pLMA and cLMA groups (64, 53 and 50 patients, respectively). Properly sized I-gel (No. 3-4) or LMA (No. 4-5) was inserted. We assessed haemodynamic data, airway leak pressure, leak volume, success rates and postoperative complications. Results There were no differences in the demographic data and haemodynamic data immediately after insertion of devices among the three groups. The airway leak pressures of the I-gel group (27.1±6.4cmH2O) and pLMA group (29.8±5.7cmH2O) were significantly higher than that of the cLMA group (24.7±6.2cmH2O). The success rates for first attempt of insertion were similar among the three groups (P=0.670). There were no differences in the incidence of adverse events except for the larger incidence of sore throat in the cLMA group. Conclusion I-gel may have a similar airway sealing to that of pLMA, higher than that of cLMA, and is not associated with adverse events. The I-gel might be an effective alternative as a supraglottic airway device. © 2010 Copyright European Society of Anaesthesiology.

Yuasa T.,Kamagaya General Hospital | Fujita K.,Tokushima University
Brain and Nerve | Year: 2010

The concept of limbic encephalitis has changed over time. Since the introduction of "limbic encephalitis" (LE) in 1968, LE was thought to almost always be associated with carcinoma; this belief led to the coining of the term "paraneoplastic limbic encephalitis" (PLE). In the 1990s, antineuronal antibodies, including anti-Hu and anti-Ta/Ma2, were detected; this supported the hypothesis of an autoimmune mechanism for PLE. The prognosis of patients with PLE was, however, poor. Since 2001, there have been reports of patients with LE exhibiting antibodies to the voltage-gated potassium channel; this observation is intriguing because in such cases the encephalitis was usually independent of carcinoma, and its clinical course was often reversible. Since the 1990s, cases of non-herpetic acute limbic encephalitis have been reported in Japan. In some of these cases, an autoantibody to GluRε2 (NR2B) has been detected; GluRε2 is a subunit of the N-methyl-D-aspartate (NMDA) glutamate receptor found in the limbic forebrain. A postulated pathophysiologic role of this antibody led to the concept of autoantibody-mediated acute reversible LE (AMED-ARLE). In 2007, some patients with ovarian teratoma developed encephalitis and exhibited antibodies to the NMDA receptor; this antibody is thought to recognize NR1/NR2 heteromers. Later, anti-NMDA receptor antibodies were also detected in some Japanese patients who had been previously diagnosed with juvenile acute non-herpetic encephalitis. Currently, limbic encephalitis is categorized into 3 groups: limbic encephalitis caused by virus infection, autoantibody-mediated limbic encephalitis (AMLE), and limbic encephalitis with autoimmune disease. In AMLE, antibodies to cytoplasmic antigens cause classical PLE (type I). In contrast, antibodies to cell membrane antigens often cause reversible limbic encephalitis in patients with (PLE type II) or without tumors (AMED-ARLE).

Hattori T.,Tokyo Medical and Dental University | Hattori T.,Juntendo University | Hattori T.,Kamagaya General Hospital | Hattori T.,Kanto Central Hospital | And 5 more authors.
American Journal of Neuroradiology | Year: 2012

BACKGROUND AND PURPOSE: The fornix contains efferent fibers of the hippocampus and is in close contact with the corpus callosum. Part of the fornix is directly attached to the corpus callosum, and another part is suspended from the corpus callosum via the septum pellucidum. DTI can be used to evaluate the morphology and microstructural integrity of the fornix. We examined the pattern of fornix damage in patients with iNPH or AD. MATERIALS AND METHODS: We enrolled 22 patients with iNPH, 20 with AD, and 20 healthy controls. DTI data were obtained. The morphology (volume, length, and mean cross-sectional area) and FA values of the fornix were evaluated by using tract-specific analysis and compared among groups. RESULTS: The volume, cross-sectional area, and FA value of the fornix were significantly smaller in patients with iNPH than in controls, whereas the length was significantly greater. In patients with AD, the volume, mean cross-sectional area, and FA value of the fornix were significantly smaller than those in controls, whereas the length was not altered. The fornix was significantly longer in patients with iNPH than in patients with AD, whereas the volume and cross-sectional areas were significantly smaller. CONCLUSIONS: Our results suggest that the different pathogeneses of these diseases lead to fornix damage through different mechanisms: through mechanical stretching due to lateral ventricular enlargement and corpus callosum deformation in patients with iNPH, and through degeneration secondary to hippocampal atrophy in patients with AD.

Nishiyama T.,Kamagaya General Hospital | Komatsu K.,University of Tokyo
Journal of Anesthesia | Year: 2010

Purpose: The aim of this study was to compare the cerebral state index (CSI) and bispectral index (BIS) during propofol-fentanyl-nitrous oxide anesthesia. Methods: Thirty patients scheduled for abdominal surgery, with a mean age of 30-70 years, were enrolled. Anesthesia was induced with propofol and fentanyl and was maintained with propofol, fentanyl, epidural mepivacaine, and nitrous oxide in oxygen. During surgery, the propofol infusion rate was adjusted to try to keep BIS at 40 ± 3 for 10 min and then decreased to keep the BIS at 60 ± 3 for 10 min. Results: The BIS had a larger value for the time between switching on the apparatus and starting to measure at a signal quality index >75%. The recovery time from disturbance by an electric cautery event was 41 ± 14 s for the BIS and 3 ± 1 s for the CSI (P < 0.05). The absolute values of the BIS and CSI were not significantly different and they showed a good correlation. The bias (mean of the differences, BIS - CSI) was negative at all measurement points, but the limits of agreement and percentage error were small. Conclusions: The absolute values of the BIS and CSI were not significantly different during propofol-fentanyl-nitrous oxide anesthesia. The start of the measurement was faster with the CSI than with the BIS after switch-on, and measurement was less disturbed by electric cautery with the CSI. © 2010 Japanese Society of Anesthesiologists.

Hattori T.,Tokyo Medical and Dental University | Hattori T.,Juntendo University | Hattori T.,Kamagaya General Hospital | Hattori T.,Kanto Central Hospital | And 10 more authors.
American Journal of Neuroradiology | Year: 2012

BACKGROUND AND PURPOSE: White matter alteration in iNPH has not been well-investigated. TBSS is a voxelwise statistical analysis developed for DTI data. We aimed to elucidate the cerebral white matter alteration in patients with iNPH by using DTI and to test the accuracy of TBSS analysis. MATERIALS AND METHODS: DTI data were obtained from 20 patients with iNPH and 20 age- and sex-matched controls. The FA values were evaluated by using TBSS, region-of-interest and tract-specific analysis of the CST. The accuracy of TBSS analysis was tested by using "back-projection" of TBSS results and by comparing the TBSS analysis results with those of region-of-interest and tract-specific analysis. RESULTS: Back-projection of the TBSS results showed accurate registration of the whole brain, with the exception of parts of the thalamus, fornix, and white matter around the posterior body of the lateral ventricle. The TBSS analysis results were consistent with those of the region-of-interest analysis and tract-specific analysis. In patients with iNPH compared with control subjects, the FA values were significantly decreased in parts of the corpus callosum, periventricular white matter, and juxtacortical white matter in the frontal and parietal lobes. In contrast, FA values were significantly increased in the internal capsule, extending to the white matter in the centrum semiovale. CONCLUSIONS: Our results suggest that patients with iNPH have various patterns of white matter damage and that TBSS analysis is a promising tool for performing accurate voxelwise statistical analysis of the iNPH brain, with the exception of misregistered areas.

Hattori T.,Tokyo Medical and Dental University | Hattori T.,Juntendo University | Hattori T.,Kamagaya General Hospital | Hattori T.,Kanto Central Hospital | And 7 more authors.
American Journal of Neuroradiology | Year: 2011

BACKGROUND AND PURPOSE: Previous neuropathologic studies in chronic hydrocephalus have suggested the presence of white matter damage, presumably from mechanical pressure due to ventricular enlargement and metabolic derangement. This study aimed to investigate the diffusional properties of the CST in patients with iNPH by using DTI and to determine whether this method could be used as a new diagnostic tool to differentiate patients with iNPH from those with AD and PDD and control subjects. MATERIALS AND METHODS: We enrolled 18 patients with iNPH, 11 patients with AD, 11 patients with PDD, and 19 healthy control subjects. Diffusion tensor metrics of the segmented CST, including FA values, axial eigenvalues, and radial eigenvalues, were evaluated by using tract-specific analysis. The anisotropy color-coding tractography of the CST was visually evaluated. The DTI findings were compared among groups. RESULTS: Tract-specific analysis of the CST showed that FA values and axial eigenvalues were significantly increased (P < .001), whereas radial eigenvalues were not significantly altered, in patients with iNPH compared with other subjects. The CST tractographic images in patients with iNPH was visually different from those in other subjects (P < .001). In discriminating patients with iNPH from other subjects, the CST FA values had a sensitivity of 94% and specificity of 80% at a cutoff value of 0.59. CONCLUSIONS: Our results suggest that patients with iNPH have altered microstructures in the CST. Quantitative and visual CST evaluation by using DTI may be useful for differentiating patients with iNPH from patients with AD or PDD or healthy subjects.

Yoshida K.,Kamagaya General Hospital
Bio-medical materials and engineering | Year: 2013

A robust method for inducing bone-formation without an autograft has not been established. Currently, both platelet-rich plasma (PRP) and bone morphogenetic protein (BMP) have been widely investigated for their clinical use in such cases. However, their synergistic effect is still controversial and previously shown diversity of this effect depends on various factors such as the bone substitutes involved. In this study, we investigated the synergistic effect of PRP and BMP2 on an alloplastic substitute as potentiators to induce in vivo bone-formation. A 10 mm diameter bony defect in rabbit calvarium was reconstructed using biphasic calcium phosphate (BCP) ceramics with or without PRP, recombinant human (rh) BMP2, and their combination. At 6 and 12 weeks after implantation, rabbits were euthanized and the radiographic and histomorphometric features of bone reconstruction were analyzed. The results showed that defects filled by rhBMP2/BCP with or without PRP had high bone density at 6 and 12 weeks in radiological evaluation. However, in histomorphometric analysis, the defects filled by rhBMP2/BCP with PRP showed significant new bone formation compared with that by rhBMP2/BCP without PRP, especially at 6 weeks. We propose that the synergistic effect of PRP and rhBMP2 gives highly osteoinductive properties to alloplastic substitutes in vivo.

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