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Kurayoshi, Japan

Hagino H.,Tottori University | Kishimoto H.,Nojima Hospital | Ohishi H.,Ajinomoto Co. | Horii S.,Takeda Pharmaceutical | Nakamura T.,National Center for Global Health and Medicine

Oral risedronate has been shown to be effective in the treatment of osteoporosis when administered once-daily or once-weekly in Japan. This randomized, double-blind, multicenter 12-month study was conducted to compare the efficacy and tolerability of oral risedronate 75mg once-monthly with 2.5mg once-daily in Japanese patients with involutional osteoporosis. Bone mineral density (BMD), biochemical markers of bone metabolism, fractures, and adverse events (AEs) were evaluated. At the end of the study (Month 12, last observation carried forward [M12, LOCF]), mean percent change (SD) from baseline in lumbar spine (L2-L4) BMD, measured by dual energy X-ray absorptiometry (primary endpoint), was increased by 5.69 (4.00)% in the 2.5mg once-daily group (n=428), and 5.98 (4.54)% in the 75mg once-monthly group (n=422). In the non-inferiority t-test (non-inferiority margin δ=1.5%), the 75mg once-monthly group was non-inferior to the 2.5mg once-daily group (p<0.0001). The difference between treatment groups was 0.28% (95% CI, -0.31% to 0.88%). Changes in biochemical markers of bone metabolism were generally comparable in the two groups, although decreases in the percent change from baseline in urinary NTX/CRN and CTX/CRN were statistically greater in the 2.5mg once-daily group than the 75mg once-monthly group. The frequency of new vertebral fractures (including aggravation of prevalent fractures) at the end of the study (M12, LOCF) was also similar in the two groups: 1.2% in the 2.5mg once-daily group and 1.3% in the 75mg once-monthly group.The incidence of mild/moderate/severe AEs was 75.5%/6.3%/0.5% in the 2.5. mg once-daily group and 77.7%/8.1%/0.7% in the 75. mg once-monthly group. AEs associated with gastrointestinal symptoms occurred in approximately 30% of subjects in each group but with no severe cases. AEs potentially associated with acute phase reaction (including symptoms of influenza-like illness or pyrexia starting within 3. days of the first dose of the study drug and with a duration of 7. days or less) only occurred in the 75. mg once-monthly group (2.1%, 9/422 subjects; influenza-like symptoms in 1 subject and pyrexia in 8 subjects), although the incidence was low without any severe cases.In conclusion, risedronate 75. mg once-monthly (a dosage which is 30 times higher than risedronate 2.5. mg once-daily) had non-inferior efficacy in terms of BMD and was similarly well tolerated compared to the once-daily regimen in Japanese patients with involutional osteoporosis. Consistent with the once-daily and once-weekly dosage, the once-monthly dosage of risedronate 75. mg was half that used outside Japan (150. mg). © 2013 The Authors. Source

Matsuura K.,Nojima Hospital | Suto C.,Tokyo Womens Medical University | Akura J.,Kushimoto Rehabilitation Center | Inoue Y.,Tottori University
Graefe's Archive for Clinical and Experimental Ophthalmology

Background: Intracameral moxifloxacin is currently administered by injecting small doses (0.05-0.2 mL) of either undiluted or diluted solutions. It is difficult to ensure delivery of small amounts of antibiotic into the area behind the intraocular lens (IOL). Moreover, the anterior chamber pressure decreases as the tip of irrigation is removed, often leading to contaminated fluid flowing into the chamber. Conventional intracameral injection administers the diluted antibiotic without irrigating the recontaminated anterior chamber. Therefore, we developed a method of intracameral moxifloxacin delivery which flushes both the anterior chamber and the area behind the IOL immediately after surgery. Methods: Surgical technique (bag and chamber flushing = BC flushing): After removing the viscosurgical device, 1.5-1.8 mL diluted moxifloxacin was injected. Both the anterior chamber and the area behind the IOL were irrigated by lifting the IOL edge so that a stream of solution could circulate behind the IOL. Experiment 1 (pig): The anterior chamber was filled with condensed milk, and irrigated with 150-fold diluted moxifloxacin (33.3 μg/mL) in six eyes (BC flushing) to observe the irrigating effect. The anterior aqueous humor was sampled. Experiment 2 (human): A conventional intracameral injection (500 μg/mL) or BC flushing (33.3 μg/mL) was followed by sampling 0.1 mL of the anterior aqueous humor in six eyes each. High-performance liquid chromatography was performed to determine antibiotic levels. Results: Experiment 1: The antibiotic concentration in the anterior chamber was 33.0 μg/mL (99.0 % was displaced). The area behind the IOL was not effectively irrigated without inserting the cannula tip. Experiment 2: The final antibiotic concentration was 152.3 μg/mL using the conventional method and 29.4 μg/mL using the BC flushing (88.3 % was displaced). Conclusion: BC flushing technique enables surgeons to completely displace the anterior chamber including the posterior IOL surface, resulting in effective irrigation and a stable antibiotic concentration in virtually all cases. © 2012 Springer-Verlag. Source

Matsuura K.,Nojima Hospital | Sasaki S.,Kushimoto Rehabilitation Center | Uotani R.,Tottori University
Clinical Ophthalmology

Purpose: Cystoid macular edema (CME) is associated with the use of prostaglandin eye drops after cataract surgery. The study aim was to report on the treatment of two CME patients with subtenon triamcinolone injections. Methods: Case one was a 70-year-old woman who underwent uneventful cataract surgery. Travoprost was administrated at 10 weeks after surgery, and CME occurred at 13 weeks after surgery. Case two was an 85-year-old man who underwent intraocular lens extraction and an intraocular lens suture operation. Latanoprost was readministered after the surgery. The patient complained of blurred vision 3 years later. Results: For both cases, discontinuation of the prostaglandin eye drops, subsequent initiation of treatment with diclofenac eye drops, and subtenon injection of triamcinolone was followed by the rapid disappearance of the CME. After the CME had disappeared for 3 months, the prostaglandin eye drops were resumed. Diclofenac was added in case two. No CME recurrence was seen in either case over 2 years. Conclusion: Subtenon triamcinolone injection can be effective for CME associated with prostaglandin eye liquid after cataract surgery. Prostaglandin eye liquid that causes CME is not necessarily precluded for future use if administered under careful observation. © 2012 Matsuura et al, publisher and licensee Dove Medical Press Ltd. Source

Matsuura K.,Nojima Hospital | Inoue Y.,Tottori University
Clinical Ophthalmology

Background: The purpose of this study was to assess the risk of intraocular contamination caused by intraocular lens (IOL) insertion with injectors by observing the dynamics of an ophthalmic viscosurgical device (OVD). Methods: Each type of injector was equipped with a colored OVD and IOL, and a 2 mm length from the tip of the cartridge was replaced with a colored OVD. The various combinations of IOLs and injectors used were: a three-piece shaped IOL, VA60BBR + TypeE1 (HOYA incision size 2.5 mm; group A, n=5); a single-piece IOL, 251+ iSert micro, preloaded (HOYA, incision size 2.2 mm; group G, n=5); and a single-piece IOL, SN6CWS preloaded (Alcon, incision size 2.7 mm; group C, n=5). Results: In group A, the intraocular OVD instantly flowed backward into the injector, whereas the colored OVD was pushed backward deep inside the cartridge without flowing into the eye. In group B, the backflow of the intraocular OVD into the injector was limited, resulting in the influx of a large amount of the colored OVD into the eye along with the IOL. In group C, as in group A, a large amount of the intraocular OVD flowed backward into the injector. Consequently, a small amount of the colored OVD flowed into the eye. Conclusion: The tip of the injector and OVD could be contaminated because the surgical field cannot be completely sterile, even after preoperative disinfection. Our experiments revealed that OVD backflow into the injector cavity occurs during IOL insertion, and this phenomenon may have minimized intraocular contamination. However, small-diameter cartridges along with plate-type haptics allow insufficient OVD backflow, resulting in intraocular influx of the contaminated OVD. Surgeons have to be notified that intraoperative bacterial contamination can occur even after IOL insertion using injectors. © 2014 Matsuura and Inoue. Source

Shinohara Y.,Tottori University | Takeuchi H.,Nojima Hospital | Uno T.,Tottori University | Watanabe T.,Tottori University | And 2 more authors.
American Journal of Neuroradiology

BACKGROUND AND PURPOSE: Flat panel detector-based CBCT can provide CT-like images of the brain without transferring patients from the angiography suite to a conventional CT facility. Conventional brain CT after uneventful endovascular treatment sometimes shows focal subarachnoid hyperattenuation with contrast leakage, mimicking SAH. Differentiating this finding from SAH is important for immediate postprocedural medical management. We investigated CBCT for detecting subarachnoid hyperattenuation immediately after coil embolization of unruptured cerebral aneurysms. MATERIALS AND METHODS: Thirty-six patients with unruptured cerebral aneurysms undergoing CBCT immediately after uncomplicated coil embolization were included. The relationship between the presence of subarachnoid hyperattenuation and total volume of contrast medium injected, aneurysm size and location, and balloon and stent assistance during embolization was investigated. Statistical analyses were performed with the χ2 test (P <.05). RESULTS: Nine of the 36 patients (25.0%) showed focal subarachnoid hyperattenuation within the relevant parent artery territory harboring the aneurysm. Subarachnoid hyperattenuation locations included the ipsilateral superior frontal sulcus (n = 5), the bilateral superior frontal sulcus (n = 1), and the ipsilateral superior frontal and precentral sulci (n = 3). Statistically significant differences were observed between the presence of a subarachnoid hyperattenuation and the total volume of contrast medium injected (P <.001) and aneurysm size (P <.05). CONCLUSIONS: Subarachnoid hyperattenuation can be detected by CBCT immediately after coil embolization for unruptured aneurysms. The increased amounts of contrast medium to be given before CBCT and the specific location of the hyperattenuation may help differentiate benign subarachnoid contrast leakage from SAH. Source

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