Saeki Y.,Osaka Minami Medical Center |
Matsui T.,NHO Sagamihara Hospital |
Saisho K.,NHO Miyakonojo Hospital |
Tohma S.,NHO Sagamihara Hospital
Expert Review of Clinical Immunology | Year: 2012
In this review, recent changes in both treatments and outcomes of rheumatoid arthritis (RA) in Japan were analyzed by viewing the National Database of Rheumatic Diseases by iR-net, one of the largest clinical databases for RA patients in Japan. Regarding drug therapy, the use of methotrexate has been continuously increasing and has established a place as an anchor drug in the treatment of RA among other nonbiologic disease-modifying antirheumatic drugs; however, the dosage used is still significantly less compared with that of western countries. In addition to methotrexate, the use of tacrolimus has increased gradually. The most prominent observed change is a rapid increase in the use of biologics, which rose to stardom in the treatment of RA in Japan and western countries. These changes in drug therapy could allow us to control RA disease activity more tightly. In line with this, the outcomes of patients with RA in Japan have been improving continuously, both clinically and functionally. Subsequently, the use of both NSAIDs and corticosteroids has decreased. In addition, overall rates of joint operations related to RA have also decreased; in particular, a significant decrease was noticed in the incidence of joint replacement and synovectomy. Overall, the trends in treatments and subsequent outcomes for RA in Japan have exactly followed those seen in western countries. © 2012 Expert Reviews Ltd.
Horiuchi T.,Minami Wakayama Medical Center |
Tanishima H.,Osaka Minami Medical Center |
Tamagawa K.,Osaka Minami Medical Center |
Sakaguchi S.,Osaka Minami Medical Center |
And 4 more authors.
Surgical Infections | Year: 2010
Background: Superficial surgical site infection (SSI) can be caused by bacterial invasion during surgery. We investigated whether bacteria are found at the wound margin during surgery and whether a wound protector (WP; Alexis® Wound Retractor; Applied Medical, Rancho Santa Margarita, CA) contributes to preventing invasion of the incision margin. Methods: We studied 272 patients who underwent gastrointestinal surgery (115 gastric, 157 colorectal, including emergency operations) between October 2005 and July 2007. The WP was used in all operations. After the intra-abdominal procedures were complete, bacterial swabs were taken from the abdominal cavity side of the WP and from the incision margin and used to prepare smears and cultures. After the swabbing, peritoneal lavage was performed using 3,000-5,000 mL of physiologic saline, and, after suture of the fascia, 500-1,000 mL of physiologic saline was used to irrigate the subcutaneous tissue. Results: Nine gastric surgery patients and 15 colorectal surgery patients had positive cultures from the abdominal cavity. No patients had positive cultures from the incision margin. Of the 24 patients with positive cultures, three suffered SSIs, all of whom had undergone colorectal surgery. Of the patients who had negative cultures, SSI occurred in only one patient, who had undergone colorectal surgery. Conclusions: These results suggest that the WP protects an incision site from bacterial invasion. © Copyright 2010, Mary Ann Liebert, Inc.
Wada Y.,Research Institute for Maternal and Child Health |
Tajiri M.,Research Institute for Maternal and Child Health |
Tajiri M.,Japan Science and Technology Agency |
Ohshima S.,Osaka Minami Medical Center
Journal of Proteome Research | Year: 2010
Profiling of oligosaccharide structures is widely utilized for both identification and evaluation of glycobiomarkers, and site-specific profiling of N-linked glycans of glycoproteins is conducted by mass spectrometry of glycopeptides, However, our knowledge of mucin-type O-glycans including site occupancy and profile variance, as well as attachment sites, is quite limited. Saccharide compositions and site-occupancy of O-glycans were calculated from the signal intensity of glycopeptide ions in the mass spectra and tandem mass spectra from electron transfer dissociation. The results for two major plasma glycoproteins, lgA1 and hemopexin, representing clustered and scattered O-glycan attachments, respectively, indicated that the variability in modifications among individuals is so small as to justify rigorous standards enabling reliable detection of disease-related alterations. Indeed, this method revealed a novel abnormality associated with rheumatoid arthritis: a significant decrease in the -acetylgalactosamine content of lgA1 O-glycans, indicating that the glycosylation abnormality is not limited to hypogalactosylation of lgG N-glycans in chronic inflammatory conditions. © 2010 Amarican Chemical Society.
Hananouchi T.,Osaka University |
Saito M.,Osaka Minami Medical Center |
Koyama T.,Osaka Minami Medical Center |
Sugano N.,Osaka University |
Yoshikawa H.,Osaka University
Clinical Orthopaedics and Related Research | Year: 2010
Malalignment of the cup in total hip arthroplasty (THA) increases the risks of postoperative complications such as neck cup impingement, dislocation, and wear. We asked whether a tailor-made surgical guide based on CT images would reduce the incidence of outliers beyond 10° from preoperatively planned alignment of the cup compared with those without the surgical guide. We prospectively followed 38 patients (38 hips, Group 1) having primary THA with the conventional technique and 31 patients (31 hips, Group 2) using the surgical guide. We designed the guide for Group 2 based on CT images and fixed it to the acetabular edge with a Kirschner wire to indicate the planned cup direction. Postoperative CT images showed the guide reduced the number of outliers compared with the conventional method (Group 1, 23.7%; Group 2, 0%). The surgical guide provided more reliable cup insertion compared with conventional techniques. Level of Evidence: Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. © 2009 The Association of Bone and Joint Surgeons ®.
Maeda Y.,Osaka Minami Medical Center |
Sugano N.,Osaka University |
Saito M.,Osaka Minami Medical Center |
Yonenobu K.,Osaka Minami Medical Center
Clinical Orthopaedics and Related Research | Year: 2011
Background: Many studies that analyzed bone mineral density (BMD) and skeletal factors of hip fractures were based on uncalibrated radiographs or dual-energy xray absorptiometry (DXA). Questions/purposes: Spatial accuracy in measuring BMD and morphologic features of the femur with DXA is limited. This study investigated differences in BMD and morphologic features of the femur between two types of hip fractures using quantitative computed tomography (QCT). Patients and Methods: Forty patients with hip fractures with normal contralateral hips were selected for this study between 2003 and 2007 (trochanteric fracture, n = 18; femoral neck fracture, n = 22). Each patient underwent QCT of the bilateral femora using a calibration phantom. Using images of the intact contralateral femur, BMD measurements were made at the point of minimum femoral-neck cross-sectional area, middle of the intertrochanteric region, and center of the femoral head. QCT images also were used to measure morphologic features of the hip, including hip axis length, femoral neck axis length, neck-shaft angle, neck width, head offset, anteversion of the femoral neck, and cortical index at the femoral isthmus. Results: No significant differences were found in trabecular BMD between groups in those three regions. Patients with trochanteric fractures showed a smaller neck shaft angle and smaller cortical index at the femoral canal isthmus compared with patients with femoral neck fractures. Conclusions: We conclude that severe osteoporosis with thinner cortical bone of the femoral diaphysis is seen more often in patients with trochanteric fracture than in patients with femoral neck fracture. Levels of Evidence: Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence. © The Association of Bone and Joint Surgeons® 2010.
Miki H.,Osaka National Hospital |
Sugano N.,Osaka University |
Yonenobu K.,Osaka Minami Medical Center |
Tsuda K.,Osaka General Medical Center |
And 2 more authors.
Clinical Biomechanics | Year: 2013
Background Dislocation is a major complication after total hip arthroplasty. Prosthesis impingement is considered to be an important cause of dislocation because impingement marks are more frequently found on retrieved cups or liners in patients who have undergone revision surgery because of dislocation (80%-94%) than in those who have undergone reoperation for other reasons (51%-56%). However, it remains a question whether impingement marks are the cause of dislocation or are instead its result. To clarify the issue, it is necessary to confirm noninvasively whether the point of impingement matches the patient's hip position when dislocation occurs. Methods Using four-dimensional patient-specific analysis, we recorded prosthesis impingement in 10 hips with instability after primary total hip arthroplasty when the patients reproduced the dislocation-causing motion. Findings We found prosthesis impingement to be related to at least instability in 6 of 10 hips with dislocation after primary total hip arthroplasty and in 4 of 4 hips that underwent revision surgery for recurrent dislocation. All impingements occurred between the anterior wall of the liner and the stem neck in posterior dislocation and between the posterior wall of the liner and the stem neck in anterior dislocation. Revision surgery in 1 of those 4 hips revealed 2 impingement marks on the retrieved liner that closely matched the prosthesis impingement point and the dislocation pathway of the metal head on the liner that were detected earlier during motion analysis. Interpretation Prosthesis impingement is an important factor in dislocation after total hip arthroplasty. © 2012 Elsevier Ltd.
Tanaka T.,Osaka Minami Medical Center |
Kanda T.,Osaka Minami Medical Center |
Sakaguchi S.,National Hospital Organization |
Munakata S.,National Hospital Organization |
Ohmichi M.,Osaka Medical College
Acta Cytologica | Year: 2012
Background: Vaginal metastasis from organs other than the uterus is rare. Generally, patients with vaginal metastasis from colorectal cancer have a dismal prognosis. Although biopsy is the best method to make the diagnosis, massive bleeding may occur. On the other hand, liquid-based cytology (LBC) has the utility to perform immunocytochemistry on additional unstained slides: we can make a diagnosis with several immunocytochemical findings. Case: A 67-year-old postmenopausal female presented to our hospital with vaginal bleeding. The patient had undergone colectomy because of her stage III sigmoid colon cancer 3 years earlier. The patient had also undergone hysterectomy for cervical cancer 30 years earlier. LBC from the vaginal stump revealed adenocarcinoma. Immunocytochemically, cancer cells were negative for cytokeratin 7 and positive for cytokeratin 20, which suggested metastasis from the sigmoid colon cancer; the diagnosis was made without a biopsy. Conclusion: When the patient has a metastatic lesion from colon adenocarcinoma, LBC with immunocytochemistry is useful in making a diagnosis. © 2012 S. Karger AG, Basel.
Ishizaki T.,Osaka Minami Medical Center |
Hayashi H.,Osaka Minami Medical Center |
Matsumoto T.,Osaka Minami Medical Center
Japanese Journal of Anesthesiology | Year: 2016
A 94-year-old female patient with femoral neck fracture received 60 ml glycerin enema prior to surgery, according to the preoperative preparation protocol. She was found unconscious and unresponsive 60 minutes after the treatment Vital signs were checked and ECG monitoring was started. The results were unremarkable and similar to those recorded at the time of admission. A neurologist was consulted, and a thorough evaluation was performed. None of physical and neurological examination, laboratory testing and urgent intracranial imaging revealed significant abnormalities or lesion responsible for the depressed consciousness. Vasovagal reflex triggered by enema and the consequent hypotension was thought to be the most likely cause of transient cerebral hypoperfusion resulting in loss of consciousness. The patient remained unresponsive for the next 2 hours, and came to open her eyes with tapping stimuli. She took another hour to fully regain consciousness without any residual neurologic deficit Her surgery was cancelled. Vasovagal reflex is known to be one of the potential complications associated with enema. Our experience suggests that the necessity of glycerin enema for preoperative bowel preparation in elderly patients should be cautiously determined and it should be given, if necessary, under adequate vigilance.
PubMed | National Kyushu Cancer Center, Tokyo Medical and Dental University and Osaka Minami Medical Center
Type: | Journal: Journal of immunology (Baltimore, Md. : 1950) | Year: 2016
PubMed | Osaka Minami Medical Center and Kinki University
Type: | Journal: Journal of medical case reports | Year: 2016
Hemophagocytic lymphohistiocytosis associated with autoimmune diseases is seen in patients with systemic juvenile idiopathic arthritis, adult-onset Stills disease, and systemic lupus erythematosus, whereas it is rarely seen in patients with dermatomyositis. In addition, central nervous system involvement with dermatomyositis is rare. To the best of our knowledge, this is the first case of hemophagocytic lymphohistiocytosis complicated by leukoencephalopathy in a patient with dermatomyositis accompanied with peripheral T-cell lymphoma.A 17-year-old Asian male adolescent with dermatomyositis and hemophagocytic lymphohistiocytosis that were controlled with corticosteroid therapy presented to our hospital with high fever and altered consciousness. Brain magnetic resonance imaging revealed multiple cerebral lesions. We diagnosed the central nervous system lesions as leukoencephalopathy secondary to dermatomyositis and hemophagocytic lymphohistiocytosis. Because corticosteroid and cyclophosphamide pulse therapy was ineffective, he was treated with a modified hemophagocytic lymphohistiocytosis-2004 protocol, which resulted in the disappearance of the lesions of his central nervous system.Our findings suggest that the hemophagocytic lymphohistiocytosis-2004 protocol including etoposide should be initiated immediately in patients with hemophagocytic lymphohistiocytosis who respond poorly to treatment for the underlying disease. Moreover, irrespective of the underlying disease, patients with hemophagocytic lymphohistiocytosis with central nervous system lesions might require bone marrow transplantation.