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Kishiwada, Japan

Fujita T.,Katsuragi Hospital | Fukunaga M.,Kawasaki Medical School | Itabashi A.,Saitama Center for Bone Research | Tsutani K.,University of Tokyo | Nakamura T.,National Center for Global Health and Medicine
Calcified Tissue International | Year: 2014

We conducted a randomized, double-blind trial to assess the effect of 28.2 μg teriparatide versus placebo (1.4 μg teriparatide) on reduction of the incidence of vertebral fractures. Individuals enrolled in this study included patients with primary osteoporosis with one to five vertebral fractures and capable of self-supported walking. Attention was focused on incident vertebral fractures, change in bone mineral density (BMD) of the lumbar spine, and safety. A total of 316 subjects participated in the study, which lasted up to 131 weeks. Incident vertebral fractures occurred in 3.3 % of subjects in the 28.2 μg teriparatide-treated group and 12.6 % of subjects in the placebo group during the 78-weeks study period. Kaplan-Meier estimates of risk after 78 weeks were 7.5 and 22.2 % in the teriparatide and placebo groups, respectively, with a relative risk reduction of 66.4 % by teriparatide (P = 0.008). Lumbar BMD in the 28.2 μg teriparatide group increased significantly by 4.4 ± 4.7 % at 78 weeks, which was significantly higher than the corresponding data in the placebo group (P = 0.001). Adverse events were observed in 86.7 % of individuals in the teriparatide group and 86.1 % of those in the placebo group. In conclusion, weekly injection of a low-dose of teriparatide (28.2 μg) reduced the risk of incident vertebral fractures and increased lumbar BMD. © 2013 The Author(s). Source

Aim: To examine factors predicting the onset of perioperative delirium and acute exacerbation of behavioral and psychological symptoms of dementia (BPSD), based on patient background, operative background and laboratory data obtained on admission, in elderly patients with proximal femoral fracture. Methods: The participants were 152 patients (aged >70 years) who underwent surgery between 1 November 2012 and 31 March 2014. The participants were classified into group B (with onset of perioperative delirium or acute exacerbation of BPSD, n = 52), or group N, (without onset, n = 100), and risk factors were retrospectively examined. Onset was judged based on the presence or absence of common items; that is, “hallucination and delusion,” “disturbing speech,” “excitatory behavior” and “altered sleep-wake cycle.” The participants were observed for 1 week after admission. Results: The incidence of perioperative delirium or acute exacerbation of BPSD was 34.2% in total. In univariate analysis, the incidence was significantly higher (P < 0.005) in group B for the age, history of dementia and serum albumin level items. In multivariate analysis, history of dementia, serum albumin level and peripheral lymphocyte count (odds ratio 3.55, 0.17, 1.00, respectively) were identified as independent predictive factors. In the subanalysis, the incidence was 91.3% in the group with a history of dementia, serum albumin level <3.7 g/dL and peripheral lymphocyte count < 1200/μL. Conclusions: History of dementia, a low serum albumin level and low peripheral lymphocyte count were found to be useful factors for predicting the onset of perioperative delirium and acute exacerbation of BPSD. Geriatr Gerontol Int 2016; 16: 821–828. © 2015 Japan Geriatrics Society Source

Tanaka T.,Katsuragi Hospital
Japanese Journal of Anesthesiology | Year: 2015

A 72-year-old woman underwent surgery for a distal radius fracture with lower jaw fracture under general anesthesia Preoperative laboratory data showed hypokalemia (3.1 mEq l-1), hypertension, and leg edema The suspected cause of all of these symptoms was the licorice component of the multiple herbal medicines which she was taking. In addition, the ephedra and aconite tuber components of the Maobushisaishinto were suspected to be contributing to the hypertension. She was therefore taken off all of her herbal medicines. The patient underwent regular blood tests and her potassium levels were replenished perioperatively. Hypokalemia was alleviated within the few days following surgery. Given the identity of the crude contents of the multiple herbal medicines in addition to the postoperative plasma renin activity and aldosterone, pseudoaldosteronism was suspected. When administering multiple herbal medicines, knowledge of the precise contents is critical. Clarification of the doses of licorice and ephedra capable of inducing hypokalemia and hypertension would also be helpful. Source

Mihata T.,Osaka Medical College | Watanabe C.,Osaka Medical College | Fukunishi K.,Osaka Medical College | Ohue M.,Katsuragi Hospital | And 3 more authors.
American Journal of Sports Medicine | Year: 2011

Background: Although previous biomechanical research has demonstrated the superiority of the suture-bridge rotator cuff repair over double-row repair from a mechanical point of view, no articles have described the structural and functional outcomes of this type of procedure.Hypothesis: The structural and functional outcomes after arthroscopic rotator cuff repair may be different between the single-row, double-row, and combined double-row and suture-bridge (compression double-row) techniques.Study Design: Cohort study; Level of evidence, 3.Methods: There were 206 shoulders in 201 patients with full-thickness rotator cuff tears that underwent arthroscopic rotator cuff repair. Eleven patients were lost to follow-up. Sixty-five shoulders were repaired using the single-row, 23 shoulders using the double-row, and 107 shoulders using the compression double-row techniques. Clinical outcomes were evaluated at an average of 38.5 months (range, 24-74 months) after rotator cuff repair. Postoperative cuff integrity was determined using Sugaya's classification of magnetic resonance imaging (MRI).Results: The retear rates after arthroscopic rotator cuff repair were 10.8%, 26.1%, and 4.7%, respectively, for the single-row, double-row, and compression double-row techniques. In the subcategory of large and massive rotator cuff tears, the retear rate in the compression double-row group (3 of 40 shoulders, 7.5%) was significantly less than those in the single-row group (5 of 8 shoulders, 62.5%, P <.001) and the double-row group (5 of 12 shoulders, 41.7%, P <.01). Postoperative clinical outcomes in patients with a retear were significantly lower than those in patients without a retear for all 3 techniques.Conclusion: The additional suture bridges decreased the retear rate for large and massive tears. The combination of the double-row and suture-bridge techniques, which had the lowest rate of postoperative retear, is an effective option for arthroscopic repair of the rotator cuff tendons because the postoperative functional outcome in patients with a retear is inferior to that without retear. © 2011 American Orthopaedic Society for Sports Medicine. Source

Mihata T.,University of California at Irvine | Mihata T.,Osaka Medical College | McGarry M.H.,University of California at Irvine | Neo M.,Osaka Medical College | And 2 more authors.
American Journal of Sports Medicine | Year: 2015

Background: Excessive anterior capsular laxity (elongation of the anterior capsular ligaments) causes shoulder subluxation during acceleration of the throwing motion, leading to a disabled throwing shoulder. Few biomechanical studies have investigated the relationship between anterior capsular laxity and internal impingement, another cause of the disabled throwing shoulder. Purpose/Hypothesis: The purpose of this study was to assess the effect of anterior capsular laxity on forceful internal impingement during the late cocking phase. The hypothesis was that excessive anterior shoulder laxity caused by elongation of the anterior capsular ligaments will increase the horizontal abduction angle to increase glenohumeral contact pressure. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric shoulders were tested with the shoulder abducted to 90° and at maximal external rotation to simulate the late cocking phase of the throwing motion. The angle of external rotation, anterior translation, angle of horizontal abduction, locations of the articular insertion of the rotator cuff tendons (supraspinatus and infraspinatus) on the greater tuberosity relative to the glenoid, and the glenohumeral contact pressure and area during internal impingement were measured. All data were compared between intact and elongated anterior capsule, which was created by repeatedly applying external rotational stretching. Results: Elongation of the anterior capsular ligaments was confirmed by the increase in glenohumeral external rotation and anterior translation after our stretching technique. Location data showed that the posterior half of supraspinatus tendon, the entire infraspinatus tendon, and the posterosuperior labrum were impinged between the greater tuberosity and glenoid. Maximal glenohumeral horizontal abduction (2.2% increase; P = .003) and glenohumeral contact pressure (27.3% increase; P = .04) were significantly increased in the shoulder joint with increased anterior capsular laxity as compared with the intact condition. Conclusion: Increased anterior capsular laxity created by applying repetitive excessive external rotational torque significantly increased horizontal abduction and contact pressure in the glenohumeral joint. Concurrently, the supraspinatus and infraspinatus tendons and posterosuperior labrum were impinged between the greater tuberosity and glenoid. Clinical Relevance: Increased anterior capsular laxity may exacerbate forceful internal impingement during the late cocking phase of the throwing motion. © 2014 The Author(s). Source

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