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PubMed | Kochi University, Kubokawa Hospital, Tokushima Bunri University and Kurihara Central Hospital
Type: Journal Article | Journal: Journal of physical therapy science | Year: 2015

[Purpose] This study aimed to investigate the differential effects of high-intensity and low-intensity transcutaneous electrical nerve stimulation on the contralateral side on the pain threshold in healthy subjects. [Subjects and Methods] Twenty-five healthy adults, volunteers received two intensity levels (motor-level, 1.5 times the muscle motor threshold; sensory-level, sensory threshold of the common peroneal nerve), for 30s on separate days. Pressure pain threshold was recorded on the contralateral tibialis anterior and deltoid muscle before, during, and after stimulation. [Results] Motor-level stimulation significantly increased the pressure pain threshold at both muscle sites, while effects of sensory-level stimulation on pressure pain thresholds were significant only at the deltoid site. The percent change in pressure pain thresholds at both sites was significantly higher during motor-level stimulation. [Conclusion] Motor-level stimulation, applied unilaterally to one leg, produced immediate contralateral diffuse and segmental analgesic effects. This may be of therapeutic benefit in patients for whom transcutaneous electrical nerve stimulation cannot be directly used at the painful site.


Akutagawa T.,Kochi Medical School Hospital | Tani T.,Kubokawa Hospital | Kida K.,Kubokawa Hospital | Tadokoro N.,Kochi Medical School | And 3 more authors.
Spinal Cord | Year: 2016

Study design:A case-control investigation.Objectives:The objective of this study was to quantitatively study impaired ability to appropriately adjust pinch strength while holding a small object in patients with cervical spondylotic myelopathy (CSM).Setting:Kochi Medical School Hospital, Japan.Methods:The subjects consisted of 19 CSM patients who had frequent episodes of failing to grasp and hold small objects in their daily life (Group A), 13 CSM patients who did not experience such episodes (Group B) and 16 healthy subjects (Control Group). We continuously measured the dynamic internal pressure of a pneumatic rubber object called a blower pinched by the subject, following two different sets of instructions: (1) pinching with eyes open and with the minimal strength required to prevent dropping; and (2) maintaining a constant pinch strength at given levels with eyes closed.Results:Compared with the other two groups, Group A subjects used a significantly (P<0.01) greater pinch strength to avoid dropping the blower held with eyes open and showed a significantly (P<0.01) greater deviation in pinch strength from the baseline values with eyes closed. These tendencies in Group A showed a significant correlation with the tactile perception threshold of the digits (P<0.01) but not with impairment of rapid repetitive movements of the digits that reflects spasticity.Conclusion:Our technique applied to CSM patients helps assess functional integrity primarily, if not exclusively, of the fasciculus cuneatus mediating the feedback signals from proprioceptive and cutaneous receptors in the digits, which are otherwise difficult to evaluate quantitatively. © 2016 International Spinal Cord Society All rights reserved.


PubMed | Kubokawa Hospital, Tokushima Bunri University, Kochi Medical School Hospital and Kochi Medical School
Type: Journal Article | Journal: Spinal cord | Year: 2016

A case-control investigation.The objective of this study was to quantitatively study impaired ability to appropriately adjust pinch strength while holding a small object in patients with cervical spondylotic myelopathy (CSM).Kochi Medical School Hospital, Japan.The subjects consisted of 19 CSM patients who had frequent episodes of failing to grasp and hold small objects in their daily life (Group A), 13 CSM patients who did not experience such episodes (Group B) and 16 healthy subjects (Control Group). We continuously measured the dynamic internal pressure of a pneumatic rubber object called a blower pinched by the subject, following two different sets of instructions: (1) pinching with eyes open and with the minimal strength required to prevent dropping; and (2) maintaining a constant pinch strength at given levels with eyes closed.Compared with the other two groups, Group A subjects used a significantly (P<0.01) greater pinch strength to avoid dropping the blower held with eyes open and showed a significantly (P<0.01) greater deviation in pinch strength from the baseline values with eyes closed. These tendencies in Group A showed a significant correlation with the tactile perception threshold of the digits (P<0.01) but not with impairment of rapid repetitive movements of the digits that reflects spasticity.Our technique applied to CSM patients helps assess functional integrity primarily, if not exclusively, of the fasciculus cuneatus mediating the feedback signals from proprioceptive and cutaneous receptors in the digits, which are otherwise difficult to evaluate quantitatively.


PubMed | Red Cross, Hamamatsu University, Kugayama Hospital, Tokyo Women's Medical University and 9 more.
Type: Journal Article | Journal: Global spine journal | Year: 2016

Study DesignSurgeon survey. ObjectiveTo analyze multimodal intraoperative monitoring (MIOM) for different combinations of methods based on the collected data and determine the best combination. MethodsA questionnaire was sent to 72 training institutions to analyze and compile data about monitoring that had been conducted during the preceding 5 years to obtain data on the following: (1) types of monitoring; (2) names and number of diseases; (3) conditions of anesthesia; (4) condition of stimulation, the monitored muscle and its number; (5) complications; and (6) preoperative and postoperative manual muscle testing, presence of dysesthesia, and the duration of postoperative motor deficit. Sensitivity and specificity, false-positive rates, and false-negative rates were examined for each type of monitoring, along with the relationship between each type of monitoring and the period of postoperative motor deficit. ResultsComparison of the various combinations showed transcranial electrical stimulation motor evoked potential (TcMEP)+cord evoked potential after stimulation to the brain (Br-SCEP) combination had the highest sensitivity (90%). The TcMEP+somatosensory evoked potential (SSEP) and TcMEP+spinal cord evoked potential after stimulation to the spinal cord (Sp-SCEP) combinations each had a sensitivity of 80%, exhibiting little difference between their sensitivity and that obtained when TcMEP alone was used. Meanwhile, the sensitivity was as low as 50% with Br-SCEP+Sp-SCEP (i.e., the cases where TcMEP was not included). ConclusionsThe best multimodality combination for intraoperative spinal cord monitoring is TcMEP+Br-SCEP, which had the highest sensitivity (90%), the lowest false-positive rate (6.1%), and the lowest false-negative rate (0.2%).


Kida K.,Kochi Medical School | Tadokoro N.,Kochi Medical School | Kumon M.,Kochi Medical School | Ikeuchi M.,Kochi Medical School | And 2 more authors.
Archives of Orthopaedic and Trauma Surgery | Year: 2014

Purpose: To determine if cantilever transforaminal lumbar interbody fusion (C-TLIF) using the crescent-shaped titanium interbody spacer (IBS) favors acquisition of segmental and lumbar lordosis even for degenerative spondylolisthesis (DS) on a long-term basis. Methods: We analyzed 23 consecutive patients who underwent C-TLIF with pedicle screw instrumentations fixed with compression for a single-level DS. Measurements on the lateral radiographs taken preoperatively, 2 weeks postoperatively and at final follow-up included disc angle (DA), segmental angle (SA), lumbar lordosis (LL), disc height (%DH) and slip rate (%slip). Results: There was a good functional recovery with 100 % fusion rate at the mean follow-up of 62 months. Segmental lordosis (DA and SA) and %DH initially increased, but subsequently decreased with the subsidence of the interbody spacer, resulting in a significant increase (p = 0.046) only in SA from 13.2 ± 5.5 preoperatively to 14.7 ± 6.4 at the final follow-up. Changes of LL and %slip were more consistent without correction loss finally showing an increase of LL by 3.6 (p = 0.005) and a slip reduction by 6.7 % (p < 0.001). Conclusions: Despite the inherent limitation of placing the IBS against the anterior endplate of the upper vertebra in the presence of DS, the C-TLIF helped significantly restore segmental as well as lumbar lordosis on a long-term basis, which would be of benefit in preventing hypolordosis-induced back pain and the adjacent level disc disease. © 2014 Springer-Verlag Berlin Heidelberg.


Nakatani H.,Kubokawa Hospital | Akimori T.,Hatakenmin Hospital | Takezaki Y.,Kochi University | Hanazaki K.,Kochi University
Journal of Medical Investigation | Year: 2010

Human carcinosarcomas of esophagus are uncommon malignant neoplasms that are composed both carcinomatous and sarcomatous components. We established a novel cell line, HN-Eso-1, from the metastatic esophageal spindle cell carcinoma (so-called carci-nosarcoma). In this study, we estimated the vascular endothelial growth factors (VEGFs) and VEGF receptors (VEGFRs). Reverse transcription polymerase chain reaction (RT-PCR) studies revealed that VEGF-A,-C,-D and VEGFR-1,-2 were upregulated. Cisplatin reduced the cell viability of HN-Eso-1 cells and VEGF attenuated its effect. These results suggest that expression of VEGF-A, VEGF-C, VEGF-D, VEGFR-1, and VEGFR-2 are involved in the cell's autocrine system and that VEGF protected these cells from the anti-tumor agent.


Nakatani H.,Noichi Central Hospital | Kumon T.,Noichi Central Hospital | Kumon M.,Noichi Central Hospital | Hamada S.,Kubokawa Hospital | And 5 more authors.
Journal of Medical Investigation | Year: 2012

Carcinoembryonic antigen (CEA) and carbohydrate antigen (CA)19-9 are well known as the most common tumor markers of colon cancer, and levels are used not only for preoperative assessment of extent and outcome of cancer, but also postoperative monitoring of recurrence. We encountered a patient with sigmoid colon cancer showing abnormally high serum levels of CEA (311.1 ng/ml) and CA19-9 (5731.2 U/ml) preoperatively.We could not detect any metastases on computed tomography (CT) or 18F-fluorodeoxyglucose positron emission tomography/CT. Sigmoidectomy and lymph node dissection were performed. Pathological analysis revealed well-differentiated tubular adenocarcinoma of the sigmoid colon with cancer cells infiltrating to the subserosa, but no lymph node metastases. As of postoperative day 60, serum levels of CEA and CA19-9 were 3.4 ng/ml and 9.2 U/ml, respectively, without any further anti-tumor treatment. This represents a rare case of sigmoid colon cancer with high levels of tumor markers in sera that improved following sigmoidectomy without further anti-cancer treatment. J. Med. Invest. 59: 280-283, August, 2012.


PubMed | Kubokawa Hospital
Type: Case Reports | Journal: The journal of medical investigation : JMI | Year: 2011

Acute appendicitis often presents as right lower quadrant (RLQ) pain, severe tenderness at the point of McBurny or Lanz, and Blumbergs sign. Scrotal events with appendicitis are very rare. In our case, a 63-year-old Japanese man presented with severe RLQ pain and high fever. Physical examination revealed severe tenderness (including both points of McBurny and Lanz) and Blumbergs sign. The scrotum was slightly swollen and showed local heat with severe testicular pain. Abdominal computed tomography revealed ascites in a pelvic space and the right side of the spermatic cord was swollen. Emergency operation was performed and the final diagnosis was catarrhal appendicitis and acute epididymitis. This is the first report of acute appendicitis concomitant with acute epididymitis.


PubMed | Kubokawa Hospital
Type: Case Reports | Journal: The journal of medical investigation : JMI | Year: 2011

Fourniers gangrene (FG) is rapidly progressing acute gangrenous infection of the anorectal and urogenital area. FG needs precocious diagnosis and aggressive treatment with the use of wide spectrum antibioticus and surgical debridement. In our case, a 91-year-old Japanese female who had rehabilitation after treatment of pneumonia and her past history was rheumatoid arthritis treated with steroid and chronic heart failure. Her activities of daily living was bedridden with dementia. Necrotic skin was observed in urogenital and anorectal area and skin redness enlarged to the hip with high fever. Surgical debridement was performed. Both Peptostreptococcus Sp. and Fusobacterium Sp. was cultured from resected necrotic tissue. We used antibioticus, PAPM and PIPC, which had sensitivity for them. But unfortunately, disseminated intravascular coagulation occurred after 4th day of operation, and finally she died after 10th day of operation. We discussed the treatment for FG in patient with complication.


PubMed | Kubokawa Hospital
Type: Case Reports | Journal: Hiroshima journal of medical sciences | Year: 2011

Patients on long-term hemodialysis are at risk of developing malnutrition,and poor nutrient intake is an important factor in this. In the present case, we encountered a 55-year-old Japanese woman with end-stage renal failure and a past history of schizophrenia. Severe systemic edema was observed. Hemodialysis was started, but after one year she suddenly became unable to consume food orally, despite provision of a dietary plan by the nutrition support team (NST). Tube feeding was eventually implemented. Because the systemic edema did not improve, we decided to remove body fluid by intense hemodialysis. Hypotension was often observed during this hemodialysis, requiring dopamine. Over approximately 2 months, the patients dry weight fell from 73 kg to 62 kg, the patients activity improved and she became able to eat orally again, allowing tube feeding to be stopped. Although the reason for the sudden anorexia has not been clarified, tube feeding and dry weight control was successful in the treatment of this malnourished hemodialysis patient.

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