Takai S.,Teikyo University |
Akagi M.,Kinki University |
Crawford B.,Adelphi Values |
Ichinohe S.,Iwate Medical University |
And 5 more authors.
Value in Health Regional Issues | Year: 2013
Objectives: Venous thromboembolism (VTE) is the most frequent complication following major orthopaedic surgery (MOS). Although studies in Western populations have demonstrated significantly higher costs for patients with VTE versus those without VTE after MOS, there is a paucity of such data in Japan. This study was conducted to understand the costs and VTE rates in Japanese patients. Methods: Data were extracted from a hospital claims database. MOS was defined as total hip replacement, total knee replacement, or hip fracture repair. Subjects who underwent more than one MOS during the same admission were excluded. Identified VTE cases were matched on a 1:2 matching scheme on the basis of surgery type, hospital, and date of surgery (±6 months). The primary outcome was the difference in 90-day costs. Secondary outcomes included differences in total 6-month costs postsurgery and average length and cost of initial hospital stay. Results: The 90-day cumulative VTE incidence was 0.774%, with 94% of the cases occurring within 30 days postsurgery. Total 90-day costs were significantly higher in patients with VTE (difference of 864,153 Japanese yen [US $10,538]). Average length of stay was longer for patients with VTE (66 days vs. 42 days). Costs incurred by patients with VTE were on average much higher than those incurred by patients without VTE throughout 5 months postsurgery. Conclusions: The development of a VTE in patients undergoing MOS results in a 1.5-fold increase in the length of stay and a 1.7-fold increase in 90-day costs. Findings indicate that the avoidance of VTEs through more effective prophylaxis will help to reduce the economic burden associated with MOS. © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
Kondo E.,Anan Kyoei Hospital |
Kawata I.,Anan Kyoei Hospital |
Takaishi T.,Tokushima Municipal Hospital |
Abe R.,Oe Kyodo Hospital |
And 4 more authors.
Practica Oto-Rhino-Laryngologica | Year: 2013
In order to clarify the role of arteriosclerosis in the development of and recovery from sudden deafness, we evaluated arteriosclerosis in patients with sudden deafness, using pulse wave velocity (PWV) as a marker. Arteriosclerosis was observed in 69% of the sudden deafness patients and the initial hearing level in the patients with arteriosclerosis was worse than those without arteriosclerosis. After treatment with a steroid and lipid microsphere- incorporated prostaglandin E1 (lipo-PGE1), the recovery rate of the patients with arteriosclerosis was significantly lower than those without arteriosclerosis. These findings suggest that arteriosclerosis is an exacerbating condition and a poor prognostic factor in patients with sudden deafness. On the other hand, PWV in the patients with arteriosclerosis who recovered tended to decrease after the treatment, suggesting that the circulation-improving effect of lipo-PGE1 may contribute to the recovery of the hearing loss related to arteriosclerosis.
Sato M.,Tokushima University |
Muguruma N.,Tokushima University |
Nakagawa T.,Tokushima University |
Okamoto K.,Tokushima University |
And 11 more authors.
Cancer Science | Year: 2014
The antitumor activity of pladienolide B, a novel splicing inhibitor, against gastric cancer is totally unknown and no predictive biomarker of pladienolide B efficacy has been reported. We investigated the antitumor activity of pladienolide B and its derivative on gastric cancer cell lines and primary cultured cancer cells from carcinomatous ascites of gastric cancer patients. The effect of pladienolide B and its derivative on six gastric cancer cell lines was investigated using a MTT assay and the mean IC50 values determined to be 1.6 ± 1.2 (range, 0.6-4.0) and 1.2 ± 1.1 (range, 0.4-3.4) nM, respectively, suggesting strong antitumor activity against gastric cancer. The mean IC50 value of pladienolide B derivative against primary cultured cells from 12 gastric cancer patients was 4.9 ± 4.7 nM, indicative of high antitumor activity. When 18 SCID mice xenografted with primary cultured cells from three patients were administered the pladienolide B derivative intraperitoneally, all tumors completely disappeared within 2 weeks after treatment. Histological examination revealed a pathological complete response for all tumors. In the xenograft tumors after treatment with pladienolide B derivative, immature mRNA were detected and apoptotic cells were observed. When the expressions of cell-cycle proteins p16 and cyclin E in biopsied gastric cancer specimens were examined using immunohisctochemistry, positivities for p16 and cyclin E were significantly and marginally higher, respectively, in the low-IC50 group compared with the high-IC50 group, suggesting the possibility that they might be useful as predictive biomarkers for pladienolide B. In conclusion, pladienolide B was very active against gastric cancer via a mechanism involving splicing impairment and apoptosis induction. The pladienolide B and its derivative showed very high anti-tumor activity against various gastric cancer cell lines and primary cultured gastric cancer cells from carcinomatous ascites in vitro and in a xenograft model. The mechanism of the anti-tumor activity of pladienolide B involves splicing impairment and apoptosis induction. © 2013 The Authors.
Nishisho T.,Tokushima University |
Hanaoka N.,Inayama Hospital |
Miyagi R.,Tokushima University |
Sakai T.,Oe Kyodo Hospital |
And 5 more authors.
Orthopedics | Year: 2015
Giant cell tumor of bone is a locally aggressive tumor with a high local recurrence rate. Several adjuvant therapies have been employed to reduce the recurrence rate, but their effectiveness remains controversial. The authors attempted local administration of zoledronic acid, a nitrogen-containing bisphosphonate that strongly inhibits bone resorption, as an adjuvant treatment for histologically proven giant cell tumor of bone in 5 patients at their institution. After biopsy, 4 patients were treated with local administration of zoledronic acid with artificial bone and 1 was treated with zoledronic acid without artificial bone. Histologic response to the treatment was evaluated with surgically resected specimens. The 4 patients treated with artificial bone showed local control, with histologic tumor necrosis rates of 90%, 90%, 50%, and 10%. Magnetic resonance imaging showed poor gadolinium enhancement, and histologic examination after local zoledronic acid treatment showed tumor necrosis. One patient without artificial bone showed no histologic tumor necrosis and had local recurrence in soft tissue 18 months after tumor resection. A 3-week waiting period between biopsy and zoledronic acid treatment appears reasonable from the histological study. Complication of this therapy was delayed wound healing and it occurred in 2 cases. Taken together, this case series suggests that local administration of zoledronic acid with artificial bone is a potential adjuvant therapy for giant cell tumor of bone. On the other hand, effective local administration of zoledronic acid requires some bone matrix, including artificial bone. Campanacci's grading is important for predicting the effect of local administration of zoledronic acid.
Soeki T.,Tokushima University |
Kitani M.,Kagawa Prefectual Shirotori Hospital |
Kusunose K.,Tokushima University |
Yagi S.,Tokushima University |
And 6 more authors.
Hypertension Research | Year: 2012
Cilnidipine, an L/N-type calcium channel blocker (CCB), has been reported to have more beneficial effects on proteinuria progression in hypertensive patients than amlodipine, an L-type CCB. The N-type calcium channel blockade that inhibits renal sympathetic nerve activity might reduce glomerular hypertension by facilitating vasodilation of the efferent arterioles. However, the precise mechanism of the renoprotective effect of cilnidipine remains unknown. Because cilnidipine exerted significantly higher antioxidant activity than amlodipine in cultured human mesangial cells, we hypothesized that cilnidipine might exert a renoprotective effect by suppressing oxidative stress. A total of 35 hypertensive patients receiving a renin-angiotensin system inhibitor were randomly assigned to a cilnidipine (n18; 10 mg per day cilnidipine titrated to 20 mg per day) or amlodipine (n17; 5 mg per day amlodipine titrated to 10 mg per day) group; the target blood pressure (BP) was set at 130/85 mmHg. After 6 months of treatment, systolic and diastolic BPs were significantly reduced in both of the groups, without any significant difference between the groups. The urinary albumin, 8-hydroxy-2′-deoxyguanosine (OHdG) and liver-type fatty-acid-binding protein (L-FABP) to creatinine ratios significantly decreased in the cilnidipine group (P0.05) compared with those in the amlodipine group. The reductions in urinary albumin, 8-OHdG and L-FABP were not correlated with the change in systolic BP. In conclusion, cilnidipine, but not amlodipine, ameliorated urinary albumin excretion and decreased urinary 8-OHdG and L-FABP in the hypertensive patients. Cilnidipine probably exerts a greater renoprotective effect through its antioxidative properties. © 2012 The Japanese Society of Hypertension All rights reserved.
Nose H.,Oe Kyodo Hospital |
Tanakami A.,Oe Kyodo Hospital |
Shimazu H.,Oe Kyodo Hospital |
Bando Y.,Oe Kyodo Hospital
Japanese Journal of Clinical Radiology | Year: 2014
We herein report a case of peliosis hepatis. A 40-year-old female with colon cancer was indicted as having an abnormal lesion in the liver. After six months, additional multiple liver lesions appeared. The lesions exhibited low density on unenhanced CT images, low intensity on T1-weighted images, high intensity on T2-weighted and a low echoic level on US. On contrast-enhanced CT and MRI, the lesion vessels penetrated the masses. Because the number of lesions increased, we suspected metastasis ; however, the masses were histopathologically proven to be peliosis hepatis.
Miyoshi H.,Oe Kyodo Hospital |
Mikami H.,Oe Kyodo Hospital |
Oba K.,Oe Kyodo Hospital |
Amari R.,Oe Kyodo Hospital
Journal of Arthroplasty | Year: 2012
In total hip arthroplasty (THA), accurately positioning the cup is crucial for achieving an adequate postoperative range of motion and stability. For 47 THA cases in which the inferomedial rim of the cup had been positioned parallel to the transverse acetabular ligament, we retrospectively performed the measurements of the radiographic cup anteversion angle relative to the anterior pelvic plane using 3-dimensional reconstruction computed tomography. The mean anteversion angle was 21.2°, with no significant difference detected in mean cup anteversion between the dysplastic hip group (15 hips) and the control group (15 hips). We suggest that the transverse acetabular ligament is a practical anatomical landmark for determining cup anteversion in THA for both dysplastic and nondysplastic hip cases. © 2012 Elsevier Inc.
Hosokawa T.,Oe Kyodo Hospital |
Hayashi H.,Oe Kyodo Hospital |
Mizuta K.,Oe Kyodo Hospital |
Hashimoto H.,Oe Kyodo Hospital
Nishinihon Journal of Urology | Year: 2015
We investigated the situation regarding the care for terminal cancer patients in our urology department within the past eight years. The number of cases of cancer death during hospitalization was 110, including 94 males and 16 females, with ages ranging from 54∼96 years old (mean age, 78.0 ± 9.2 years; median, 79). Primary diseases comprised 60 prostatic cancers, 37 urothelial cancers, 4 renal cell carcinomas, and 9 other diseases. The duration of hospitalization ranged from 2∼574 days (mean duration, 81.0 ± 105.2 days; median, 45), with a hospitalization of three months or more being experienced by 22.7% of patients. The medical reasons for protracted hospitalization were the administration of medical treatment for primary disease, difficulty with pain control, gross hematuria which needed irrigation, paralysis caused by osseous metastasis, consciousness disorder due to brain metastasis, and the emergence of infection. The difficulty in being cared for at home was one of the reasons for hospitalization, either because the patient lived alone or because they lived with their spouse who was of an advanced age. Although our policy guidance regarding patients being cared for at home is advanced, our research revealed that it is difficult for family members to accept responsibility for providing home nursing care during the end term of a patient's life under the present conditions.
Abe A.,Oe Kyodo Hospital |
Ikawa H.,Oe Kyodo Hospital |
Ikawa S.,Oe Kyodo Hospital
Journal of Medical Investigation | Year: 2010
Platinum-based chemotherapy is the standard regimen for the treatment of gynecologic cancers; however, hypersensitivity reactions (HR) to platinum often lead to discontinuation of this effective treatment. Here we performed a desensitization protocol for platinum infusion in 3 patients who required platinum re-administration after developing HR. Two patients (Case 1 and 2) were treated with the desensitization protocol successfully without developing HR during the subsequent 3 courses. Case 3 tolerated desensitization well for 2 courses, but in the 3rd course, she developed severe HR immediately after the initiation of cisplatin infusion because the desensitization protocol was unintentionally omitted. These cases show the usefulness and effectiveness of the desensitization protocol for the continuation of platinum treatment in patients who have undergone an extended number of treatments.
Nakao T.,Oe Kyodo Hospital |
Shinohara H.,Oe Kyodo Hospital |
Toyota T.,Oe Kyodo Hospital |
Kinoshita T.,Oe Kyodo Hospital |
Yoshida S.,Oe Kyodo Hospital
Japanese Journal of Gastroenterological Surgery | Year: 2012
We report a case of rectosigmoid cancer that developed after a living-donor liver transplantation. A 54-year-old woman underwent a living-donor liver transplantation for hepatic failure caused by primary biliary cirhhosis. The liver graft had been donated by her son. The immunosuppressive agents (tacrolimus hydrate and mycophenolate mofetil. were administered after a living-donor liver transplantation. Computed tomography (CT. and colonoscopy were performed because of bloody stool 7 years after transplantation. CT showed thickening of the rectosigmoid wall and no hepatic tumor. Colonoscopy showed a Borrmann 3 type tumor in the rectosigmoid region and the histological findings of the biopsy specimen showed Class V (tub2). We performed rectosigmoidectomy with lymph node dissection. Pathological diagnosis suggested moderately differentiated adenocarcinoma (pSS, pN1, Cy1, INFb, ly1, v1, pPM0, pDM0, pRM0, Stage IIIa). The postoperative course was uneventful without anastomotic insufficiency, and she was discharged on postoperative day 10. We administered adjuvant mFOLFOX6 and UFT, together with immunosuppressive agents. The patient died of hepatorenal failure caused by trauma. Because the number of malignancies in patients following liver transplantation is expected to increase, close surveillance in transplant recipients reated with immunosuppressive agents is important, in order to make a timely diagnosis. © 2012 The Japanese Society of Gastroenterological Surgery.