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Takayama K.,Ishinkai Yao General Hospital | Taoka T.,Nara Medical University | Nakagawa H.,Nara Prefectural Nara Hospital | Myouchin K.,Ishinkai Yao General Hospital | And 6 more authors.
American Journal of Neuroradiology | Year: 2012

BACKGROUND AND PURPOSE: Restenosis after CAS is a postoperative problem, with a reported frequency of approximately 2%-8%. However differences in stent design, procedure, and the anti-platelet agent appear to affect the incidence of restenosis. We assessed the frequency of restenosis and the effect of the antiplatelet agent CLZ in preventing restenosis after CAS by the standard procedure using the CWS. MATERIALS AND METHODS: Between May 2010 and October 2011, 62 lesions in 60 consecutive patients underwent CAS using the CWS at 4 medical institutions, and all patients were followed clinically and assessed by sonography, 3D-CTA, or angiography at 3 and 6 months postoperatively. Restenosis was defined as ≥50% stenosis. The incidence of restenosis and the variation in the incidence of restenosis by the difference in type of antiplatelet agent between the CLZ group (n = 30; aspirin, 100 mg, and CLZ, 200 mg) and the non-CLZ group (n = 32; aspirin, 100 mg, and clopidogrel, 75 mg [n = 29]; or ticlopidine, 100 mg [n = 2] or 200 mg [n = 1]) were retrospectively investigated. Two antiplatelet agents were given starting 1 week preoperatively until at least 3 months postoperatively. RESULTS: Restenosis occurred in 5 patients (8.3%), but all were cases of asymptomatic lesions in the follow-up period. All 5 patients with restenosis were in the non-CLZ group, with no cases of restenosis in the CLZ group; the difference was significant (P = .0239). CONCLUSIONS: The restenosis rate after CAS by using the CWS was 8.3%. CLZ was associated with significant inhibition of restenosis. Source

Okuda M.,Ishinkai Yao General Hospital | Omokawa S.,Nara Medical University | Okahashi K.,Nara Prefectural Nara Hospital | Akahane M.,Nara Medical University | Tanaka Y.,Nara Medical University
Journal of Orthopaedic Science | Year: 2012

Background: A variety of outcome measures are available to evaluate physical impairment and disability in patients with knee osteoarthritis, and most physician-rated measures are not validated. The objective of this study was to assess the validity and reliability of an observer-based knee scoring system of the Japanese Orthopaedic Association (the JOA) commonly used in Japanese clinical practice, and to determine demographic variables affecting the score. Methods: A consecutive series of 85 patients with primary knee osteoarthritis completed the JOA (four domains pain on walking, pain on ascending or descending stairs, range of motion, and joint effusion), two validated patient-rated measures including the generic instrument of the Medical Outcomes Study 36-Item Short-Form (the SF-36) Health Survey, and the disease-specific scale of the Japanese Knee Osteoarthritis Measure (the JKOM), and a performance based timed-up-and-go test (TUG). Concurrent validity was determined by examining correlations of the JOA with the SF-36 and the JKOM. Construct validity was verified by correlating each domain of the JOA with objective measurements of TUG using Spearman's rank correlation coefficient. Intra- and interobserver reliability and internal consistency of the JOA were evaluated with another cohort of 32 patients who had a knee disorder at baseline and again at a mean of 18 days later. Results: The JOA was significantly correlated with validated patient-rated outcome measures (the JKOM, the SF-36), indicating concurrent validity of the JOA. Domains of the JOA had significant correlations with the TUG, showing adequate construct validity. Intra- and interobserver reliability for the JOA showed a moderate to almost perfect agreement, and internal consistency of Cronbach's α indicated that the JOA score was a highly reliable instrument to assess knee osteoarthritis. As a demographic variable, age was highly correlated with the JOA. Conclusions: The JOA, generally used as an observer-derived knee scoring system, is a valid and reliable tool for evaluating functional status in patients with knee osteoarthritis. © 2012 The Japanese Orthopaedic Association. Source

Fujiwara K.,Nara Prefectural Nara Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013

A 60-year-old man had a medical examination because of fever in the emergency hospital and had a diagnosis of pneumonia and was treated, but he was admitted to our hospital 2 days later because there was not the improvement of his symptom. The chest computed tomography(CT)image showed multilocular pleural effusions and lower lobe atelectasis with the air bronchogram on the left side. We diagnosed the case as empyema and inserted a catheter, but drainage was very few and injected 60,000 urokinase units for 3 days from the next day. We removed a drain 2 days after the 3rd infusion, and the pleural thickening became mild, and atelectasis was gradually improved in the chest CT image, and the inflammatory reaction was reduced, too. The intrathoracic washing with urokinase was thought to be effective for empyema with atelectasis. Source

Ito K.,Kansai Rosai Hospital | Tsubamoto H.,Hyogo College of Medicine | Itani Y.,Nara Prefectural Nara Hospital | Kuroboshi H.,Kyoto Prefectural University of Medicine | And 3 more authors.
Gynecologic Oncology | Year: 2011

Objectives.: The optimal chemotherapy regimen for women with endometrial cancer has not been established. We assessed the feasibility, toxicity and clinical efficacy of combination triweekly carboplatin and weekly paclitaxel in women with endometrial cancer. Methods.: Eligible patients had histologically confirmed primary advanced or recurrent endometrial cancer (Group A), or had localized high-risk features (Group B). All were treated with paclitaxel 80 mg/m2 (days 1, 8 and 15) and carboplatin AUC 5 (day 1) each 21-day cycle. A minimum of 3 cycles was planned; if 75% or more of patients were able to receive at least 3 cycles with acceptable toxicity, the regimen was declared "feasible." Results.: Forty patients were enrolled and administered 163 cycles of therapy; 38 (95%) were chemo-naive. No patients received radiation previously. Group A (measurable disease) contained 15 patients (5 with recurrent disease, 7 receiving neo-adjuvant chemotherapy, and 3 treated adjuvantly following suboptimal cytoreduction). Group B (non-measurable disease) contained 25 patients (primary stage I:10, II:5, III:8, IV:1 and relapse 1). Hematological toxicities(G3/G4) were neutropenia (31%/33%) and thrombocytopenia (6%/0%). Reversible G3 hypersensitivity (5%) and G2 cardiotoxicity (3%) was uncommon. Thirty-one patients (78%) completed ≥ 3 cycles (median 4, range: 1-9). Thirteen of 15 (87%) measurable patients responded (3CR, 10PR). Eighty-seven percent of measurable patients were not progressive at 6 months. In Group A, QOL scores were significantly improved after 3 cycles of chemotherapy (p = 0.037), and at the completion of chemotherapy (p = 0.045). QOL scores in Group B did not change during therapy. Conclusions.: This combination chemotherapy is feasible and effective for endometrial cancer patients. © 2010 Elsevier Inc. All rights reserved. Source

Amano M.,Nara Prefectural Nara Hospital | Shimizu T.,Nerima Hikarigaoka Hospital
Internal Medicine | Year: 2014

Emphysematous cystitis (EC) is a rare form of complicated urinary tract infection, its characteristic feature being gas within the bladder wall and lumen. Patients with EC present with variable clinical manifestations ranging from asymptomatic to severe sepsis. EC is typically observed in elderly women with severe diabetes mellitus. Escherichia coli and Klebsiella pneumoniae are often isolated from urine cultures. Imaging methods, such as plain conventional abdominal radiography and computed tomography, are pivotal for obtaining a definitive diagnosis of EC. Most cases can be treated with a combination of antibiotics, bladder drainage and glycemic control. EC is potentially life-threatening, with a mortality rate of 7%. Early medical intervention can contribute to achieving a favorable prognosis without the need for surgical intervention. In this review, we provide a comprehensive description of the clinical characteristics of EC. © 2014 The Japanese Society of Internal Medicine. Source

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