Kishiwada, Japan
Kishiwada, Japan

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Nakamura T.,University of Occupational and Environmental Health Japan | Sugimoto T.,The University of Shimane | Nakano T.,Tamana Central Hospital | Kishimoto H.,Sanin Rosai Hospital | And 8 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2012

Context: Weekly teriparatide injection at a dose of 56.5 μg has been shown to increase bone mineral density. Objective: A phase 3 study was conducted to determine the efficacy of once-weekly teriparatide injection for reducing the incidence of vertebral fractures in patients with osteoporosis. Design and Setting: In this randomized, multicenter, double-blind, placebo-controlled trial conducted in Japan, the incidence of morphological vertebral fractures by radiographs was assessed. Patients: Subjects were 578 Japanese patients between the ages of 65 and 95 yr who had prevalent vertebral fracture. Intervention: Subjects were randomly assigned to receive once-weekly sc injections of teriparatide (56.5 μg) or placebo for 72 wk. Main Outcome Measure: The primary endpoint was the incidence of new vertebral fracture. Results: Once-weekly injections of teriparatide reduced the risk of new vertebral fracture with a cumulative incidence of 3.1% in the teriparatide group, compared with 14.5% in the placebo group (P < 0.01), and a relative risk of 0.20 (95% confidence interval, 0.09 to 0.45). At 72 wk, teriparatide administration increased bone mineral density by 6.4, 3.0, and 2.3% at the lumbar spine, the total hip, and the femoral neck, respectively, compared with the placebo (P < 0.01). Adverse events (AE) and the dropout rates by AE were more frequently experienced in the teriparatide group, but AE were generally mild and tolerable. Conclusion: Weekly sc administration of teriparatide at a dose of 56.5 μg may provide another option of anabolic treatments in patients with osteoporosis at higher fracture risk. Copyright © 2012 by The Endocrine Society.


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).


Takaishi Y.,Takaishi Dental Clinic | Takaishi Y.,Osaka Dental University | Ikeo T.,Osaka Dental University | Nakajima M.,Osaka Dental University | And 2 more authors.
Osteoporosis International | Year: 2010

Alveolar bone mineral density (BMD) measured by radiography standardized by aluminum step wedge pasted on the film and digitized by a computer system was significantly higher around osteonecrosis lesions than in control cases in a pilot case-control study. High alveolar bone density appears useful as a local risk factor for bisphosphonate-related osteonecrosis of the jaw (BRONJ). Introduction: In an attempt to find a reliable test method predicting the occurrence of BRONJ in addition to various risk factors suggested, an increase of alveolar bone density near the necrotic lesions was found by computerized radiogrammetry using dental films pasted with an aluminum step wedge (Bone Right®, DentalgraphiċCom Company, Himeji) in six cases of BRONJ. Methods: The bone mineral density surrounding the osteonecrosis lesions showed distinctly higher density in BRONJ cases compared with age-matched controls. In one subject on bisphosphonate treatment in whom two extractions were simultaneously carried out, BRONJ occurred only at the location with extremely high alveolar bone density, but not at the other site with normal density. Conclusion: This method may be useful in detecting a rise of alveolar BMD frequently occurring near the necrotic lesion in subjects with impending risk for BRONJ.


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.


Mihata T.,Osaka Medical College | Mihata T.,University of California at Irvine | Lee T.Q.,University of California at Irvine | Watanabe C.,Osaka Medical College | And 4 more authors.
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2013

Purpose: The objective of this study was to investigate the clinical outcome and radiographic findings after arthroscopic superior capsule reconstruction (ASCR) for symptomatic irreparable rotator cuff tears. Methods: From 2007 to 2009, 24 shoulders in 23 consecutive patients (mean, 65.1 years) with irreparable rotator cuff tears (11 large, 13 massive) underwent ASCR using fascia lata. We used suture anchors to attach the graft medially to the glenoid superior tubercle and laterally to the greater tuberosity. We added side-to-side sutures between the graft and infraspinatus tendon and between the graft and residual anterior supraspinatus/subscapularis tendon to improve force coupling. Physical examination, radiography, and magnetic resonance imaging (MRI) were performed before surgery; at 3, 6, and 12 months after surgery; and yearly thereafter. Average follow-up was 34.1 months (24 to 51 months) after surgery. Results: Mean active elevation increased significantly from 84° to 148° (P <.001) and external rotation increased from 26° to 40° (P <.01). Acromiohumeral distance (AHD) increased from 4.6 ± 2.2 mm preoperatively to 8.7 ± 2.6 mm postoperatively (P <.0001). There were no cases of progression of osteoarthritis or rotator cuff muscle atrophy. Twenty patients (83.3%) had no graft tear or tendon retear during follow-up (24 to 51 months). The American Shoulder and Elbow Surgeons (ASES) score improved from 23.5 to 92.9 points (P <.0001). Conclusions: ASCR restored superior glenohumeral stability and function of the shoulder joint with irreparable rotator cuff tears. Our results suggest that this reconstruction technique is a reliable and useful alternative treatment for irreparable rotator cuff tears. Level of Evidence: Level IV, therapeutic case series. © 2013 by the Arthroscopy Association of North America.


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


Nakase C.,First Towakai Hospital | Mihata T.,First Towakai Hospital | Mihata T.,Osaka Medical College | Mihata T.,Katsuragi Hospital | And 3 more authors.
American Journal of Sports Medicine | Year: 2016

Background: Humeral retroversion physiologically decreases during growth. However, in throwing athletes, the external forces caused by repetitive throwing are thought to increase humeral retroversion on the dominant side compared with that on the nondominant side. Purpose: To investigate the correlation between humeral retroversion and length of baseball career before age 16 years. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 112 high school baseball players (32 pitchers and 80 position players) with a mean age of 15.6 years (range, 15-16 years) were enrolled in the study. All participants completed questionnaires regarding their player position and the age when they started baseball and were given physical examinations. Shoulder range of motion and humeral retroversion were assessed on the dominant and nondominant sides. Humeral retroversion (rotation angle of the proximal humerus relative to the distal humerus) was measured ultrasonographically. Results: Humeral retroversion was significantly greater on the dominant side than on the nondominant side in both pitchers (P <.0001) and position players (P =.0005). The side-to-side difference in humeral retroversion in pitchers (13.9° ± 11.2°) was significantly greater than that in position players (9.0° ± 11.1°, P =.0361). In pitchers, there was a significant negative correlation between humeral retroversion and the age at which the players had started baseball (P =.033, β = -2.494). Conclusion: These results suggest that humeral retroversion increases with decreasing age at commencement of a baseball career before age 16 years in pitchers. © American Orthopaedic Society for Sports Medicine.


Mihata T.,University of California at Irvine | Mihata T.,Osaka Medical College | Mihata T.,Katsuragi Hospital | McGarry M.H.,University of California at Irvine | And 4 more authors.
American Journal of Sports Medicine | Year: 2016

Background: Acromioplasty is increasingly being performed for both reparable and irreparable rotator cuff tears. However, acromioplasty may destroy the coracoacromial arch, including the coracoacromial ligament, consequently causing a deterioration in superior stability even after superior capsule reconstruction. Purpose/Hypothesis: The purpose of this study was to investigate the effects of acromioplasty on shoulder biomechanics after superior capsule reconstruction for irreparable supraspinatus tendon tears. The hypothesis was that acromioplasty with superior capsule reconstruction would decrease the area of subacromial impingement without increasing superior translation and subacromial contact pressure. Study Design: Controlled laboratory study. Methods: Seven fresh-frozen cadaveric shoulders were evaluated using a custom shoulder testing system. Glenohumeral superior translation, the location of the humeral head relative to the glenoid, and subacromial contact pressure and area were compared among 4 conditions: (1) intact shoulder, (2) irreparable supraspinatus tendon tear, (3) superior capsule reconstruction without acromioplasty, and (4) superior capsule reconstruction with acromioplasty. Superior capsule reconstruction was performed using the fascia lata. Results: Compared with the intact shoulder, the creation of an irreparable supraspinatus tear significantly shifted the humeral head superiorly in the balanced muscle loading condition (without superior force applied) (0° of abduction: 2.8-mm superior shift [P =.0005]; 30° of abduction: 1.9-mm superior shift [P =.003]) and increased both superior translation (0° of abduction: 239% of intact [P =.04]; 30° of abduction: 199% of intact [P =.02]) and subacromial peak contact pressure (0° of abduction: 308% of intact [P =.0002]; 30° of abduction: 252% of intact [P =.001]) by applying superior force. Superior capsule reconstruction without acromioplasty significantly decreased superior translation (0° of abduction: 86% of intact [P =.02]; 30° of abduction: 75% of intact [P =.002]) and subacromial peak contact pressure (0° of abduction: 47% of intact [P =.0002]; 30° of abduction: 83% of intact [P =.0005]; 60° of abduction: 38% of intact [P =.04]) compared with after the creation of a supraspinatus tear. Adding acromioplasty significantly decreased the subacromial contact area compared with superior capsule reconstruction without acromioplasty (0° of abduction: 26% decrease [P =.01]; 30° of abduction: 21% decrease [P =.009]; 60° of abduction: 61% decrease [P =.003]) and did not alter humeral head position, superior translation, or subacromial peak contact pressure. Conclusion: Superior capsule reconstruction repositioned the superiorly migrated humeral head and restored superior stability in the shoulder joint. Adding acromioplasty decreased the subacromial contact area without increasing the subacromial contact pressure. Clinical Relevance: When superior capsule reconstruction is performed for irreparable rotator cuff tears, acromioplasty may help to decrease the postoperative risk of abrasion and tearing of the graft beneath the acromion. © 2015 The Author(s.


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.


Fujita T.,Katsuragi Hospital | Fujita T.,Calcium Research Institute | Fujii Y.,Calcium Research Institute | Munezane H.,Calcium Research Institute | And 3 more authors.
Journal of Bone and Mineral Metabolism | Year: 2010

To assess the effect of raloxifene on bone and joint pain, 24 postmenopausal women with back or knee pain or both were randomly divided into two groups, based on the chronological sequence of consultation, to be treated with 60 mg raloxifene and 1 μg alfacalcidol (RA)/day (group RA) or 1 μg alfacalcidol alone (A)/day (group A), respectively, for 6 months. Pain following knee loading (KL) by standing up from a chair and bending the knee by squatting, knee and spine loading (KSL) by walking horizontally and ascending and descending stairs, and spine loading (SL) by lying down supine on a bed and leaving the bed to stand was evaluated by electroalgometry (EAM), based on measurement of the fall of skin impedance, and a visual rating scale (VRS), recording subjective pain on a scale of 0-100 between no pain and unbearable pain. The two groups showed no significant difference as to age, indices of mineral metabolism, back and knee pain, and bone status. RA gave a significantly greater analgesic effect than A by both EAM (P = 0.0158) and VRS (P = 0.0268) on overall comparison of the mean response to all modalities of exercise loading. Paired comparison between pretreatment and posttreatment indicated a significant effect of RA by both EAM (P = 0.0045) and VRS (P = 0.0017), but not that of A. The analgesic effect was more clearly noted on combined knee-spine loading (KSL) and spine loading (SL) than simple knee loading (KL). Monthly comparison of the analgesic effect indicated a significantly better analgesic effect in the fifth month by VRS. RA effect greater than A was more evident by EAM than VRS and during months 3-6 than during 1-2 months, suggesting a slowly progressive effect of RA. Pain evaluation by EAM and VRS mostly gave parallel results, except for a few occasions such as knee loading and spine loading by sitting up and leaving a bed, when EAM detected a positive effect but VRS failed to do so. RA appeared to be more effective on bone and joint pain than A in postmenopausal women according to both EAM and VRS measurements. © The Japanese Society for Bone and Mineral Research and Springer 2010.

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