Sendai-shi, Japan
Sendai-shi, Japan

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Kurosawa D.,Sendai Shakaihoken Hospital | Murakami E.,Sendai Shakaihoken Hospital | Aizawa T.,Tohoku University
European Spine Journal | Year: 2015

Methods: The study included 50 patients with SIJ dysfunction, confirmed by more than 70 % pain relief after periarticular injection of local anesthetic into the SIJ. The posterior SIJ was divided into four sections—upper, middle, lower, and other (cranial portion of the ilium outside the SIJ)—designated sections 1, 2, 3, and 0, respectively. We then inserted a needle into the periarticular SIJ under fluoroscopy. After the patient identified the area(s) in which the needle insertion produced referred pain, we injected a mixture of 2 % lidocaine and contrast medium into the corresponding SIJ section.Results: Referred pain from SIJ section 0 was mainly located in the upper buttock along the iliac crest; pain from section 1, around the posterosuperior iliac spine; pain from section 2, in the middle buttock area; pain from section 3, in the lower buttock. In all, 22 (44.0 %) patients complained of groin pain, which was slightly relieved by lidocaine injection into SIJ sections 1 and 0.Conclusions: Dysfunctional upper sections of the SIJ are associated with pain in the upper buttock and lower sections with pain in the lower buttock. Groin pain might be referred from the upper SIJ sections.Purpose: Pain referred from the sacroiliac joint (SIJ) may originate in the joint’s posterior ligamentous region. The site of referred pain may depend on which SIJ section is affected. This study aimed to determine the exact origin of pain referred from four SIJ sections. © 2014, Springer-Verlag Berlin Heidelberg.


Tokodai K.,Sendai Shakaihoken Hospital | Takayama T.,Sendai Shakaihoken Hospital | Amada N.,Sendai Shakaihoken Hospital | Haga I.,Sendai Shakaihoken Hospital | And 2 more authors.
Urology | Year: 2013

Objective To evaluate the effect of the learning curve for the hybrid technique of retroperitoneoscopic living donor nephrectomy (RDN) on donor and recipient outcomes. Methods We retrospectively reviewed 120 consecutive patients who underwent RDN, performed by a laparoscopic surgeon, at Sendai Shakaihoken Hospital between May 2005 and September 2011. A new hybrid technique, in which 2 laparoscopic ports were inserted through a hand-port device and all the procedures except mobilization and taping of ureter and extracting kidney were performed with nonhand-assisted technique, was used. These 120 patients were classified into 4 groups (groups 1-4) of 30 patients each on the basis of the order in which they were operated on by the surgeon. Results Baseline data including donors' age, gender, and body mass index did not differ among the groups. The time required for graft extraction and overall operative time were significantly longer in group 1 than in the other 3 groups. However, warm ischemia time, blood loss, length of postoperative hospital stay, and graft function did not differ among the groups. Conclusion These results indicate that the hybrid technique of RDN could be performed by surgeons with acceptable outcomes, in donors and recipients, even during the early stages of practicing RDN. Although the time required for graft extraction and overall operative time were much longer during the learning phase, the learning curve was short and improved rapidly after performing only 30 procedures. © 2013 Elsevier Inc.


Tokodai K.,Sendai Shakaihoken Hospital | Amada N.,Sendai Shakaihoken Hospital | Kikuchi H.,Sendai Shakaihoken Hospital | Haga I.,Sendai Shakaihoken Hospital | And 2 more authors.
Transplantation Proceedings | Year: 2013

Background: New-onset diabetes after transplantation (NODAT) is a serious metabolic complication that can follow kidney transplantation. Several risk factors, including obesity, have been related to NODAT development. Obesity is defined as an excessive accumulation of body fat, and body fat percentage (BF%) has been commonly measured by different techniques, including bioelectrical impedance analysis. However, the correlation between an increase in BF% and the development of NODAT during outpatient follow-up has not yet been explored. We aimed to elucidate the association between BF% changes and the development of NODAT. Methods: We performed a retrospective study involving 45 patients without diabetes who underwent kidney transplantation in our hospital between March 2008 and December 2010. We compared the BF% and demographic variables of patients who did and did not develop NODAT during follow-up. Results: Four patients (8.9%) developed NODAT during a mean follow-up period of 30.3 months. The post-transplantation increase in BF% was much higher in NODAT+ patients than the NODAT- patients. Univariate analysis indicated that the rate of increase in BF% was a risk factor for NODAT (hazard ratio [HR], 1.08 [1.02-1.18]; P <.005). Conclusions: A large increase in BF% may be a risk factor for NODAT. These findings underline the importance of routine BF% measurements in medical practice. © 2013 Elsevier Inc. All rights reserved.


Hotta O.,Sendai Shakaihoken Hospital
Advances in Oto-Rhino-Laryngology | Year: 2011

IgA nephropathy (IgAN), the most common form of primary glomerulonephritis progressing to end-stage renal disease (ESRD), has been regarded as an incurable disease. However, in recent years, it has been demonstrated that combined tonsillectomy with steroid pulse (TS) therapy, if administrated in the relatively early stage of the disease, can yield clinical remission in patients with IgAN. However, clinical remission is no longer obtained when the same treatment is administrated in cases with more advanced disease and/or a longer duration of nephropathy. Thus, the paradigm of managing IgAN patients is shifting in Japan from 'slowing the progression and the delaying the onset of ESRD' (by conventional therapy using a RAS inhibitor and/or corticosteroids at low doses in selected patients with advanced IgAN) to 'achieving remission' by the TS therapy in patients with early disease. In the new paradigm aimed at clinical remission, the principle for initiation of TS therapy should be 'the earlier, the better'. Copyright © 2011 S. Karger AG, Basel.


Suzuki Y.,Juntendo University | Matsuzaki K.,Juntendo University | Suzuki H.,Juntendo University | Sakamoto N.,National Health Research Institute | And 4 more authors.
Clinical and Experimental Nephrology | Year: 2014

Background: The remission criteria of immunoglobulin A (IgA) nephropathy have varied depending on the clinical study. Therefore, nephrologists cannot make a uniform assessment of treatment outcomes and the standardization of explanations of the condition is difficult in patients with IgA nephropathy. This study aims to propose clinical remission criteria for IgA nephropathy based on a nationwide opinion survey in Japan regarding IgA nephropathy remission/relapse. Method: This nationwide survey was sent to 312 teaching facilities of the Japanese Society of Nephrology by Progressive Renal Disease Research, Research on Intractable Disease, from the Ministry of Health, Labour and Welfare of Japan. Results: Valid answers were obtained from 193 facilities (61.9 %) (136 internal medicine facilities and 57 pediatric facilities), of which 134 (69.4 %) thought that both hematuria and proteinuria should be used in the remission standards. Approximately half of the survey respondents shared the opinion on standards of negative results for hematuria and proteinuria and the duration and frequency of these conditions. Conclusion: In this paper, we propose a standardized set of criteria for defining IgA nephropathy remission: three consecutive negative results over a 6-month period in urinary occult blood tests; urinary sediment red blood cell count of <5/high-power field (hematuria remission); and urinary protein of <0.3 g/day (g/g Cr; proteinuria remission). Clinical remission is defined as cases with both hematuria and proteinuria remission. These consensus-based remission criteria should be verified in future studies. In the meantime, they may be useful in predicting therapeutic outcome in cases of IgA nephropathy. © 2013 Japanese Society of Nephrology.


Tokodai K.,Sendai Shakaihoken Hospital | Amada N.,Sendai Shakaihoken Hospital | Haga I.,Sendai Shakaihoken Hospital | Takayama T.,Sendai Shakaihoken Hospital | Nakamura A.,Sendai Shakaihoken Hospital
Diabetes Research and Clinical Practice | Year: 2014

Aims: To evaluate the predictive power of the 5-time point oral glucose tolerance test (OGTT) for new-onset diabetes after kidney transplantation (NODAT). Methods: We performed a retrospective study of 145 patients without diabetes who received kidney transplantations at our hospital. The 5-time point OGTT was performed before transplantation. The area under a receiver-operating characteristic curve (aROC) was used for evaluating the predictive power of 5-time point OGTT values. Results: Seventeen patients developed NODAT within 1 year after transplantation. All postload plasma glucose (PPG) levels were higher in patients who developed NODAT than in those who did not; fasting plasma glucose levels were not different. The aROC for the area under the glucose concentration-time curve was significantly greater than that for fasting plasma glucose. Univariate and multivariate analyses showed that each PPG level was an independent risk factor for NODAT. Furthermore, patients with normal glucose tolerance (NGT) or impaired glucose tolerance (IGT) could be stratified with a 1-h plasma glucose (1h-PG) cut-off point of 8.4. mmol/L. The incidences of NODAT were 23.5%, 16.7%, 9.1%, and 0% for patients with IGT. +. 1h-PG ≥8.4. mmol/L,IGT. +. 1h-PG <8.4. mmol/L, NGT. +. 1h-PG ≥ 8.4. mmol/L, and NGT. +. 1h-PG. <. 8.4. mmol/L, respectively. Conclusions: The area under the glucose concentration-time curve and each PPG concentration during the 5-time point OGTT are strong predictors of NODAT. A 1h-PG cut-off point of 8.4. mmol/L plus NGT/IGT can be used to identify patients at intermediate and high risk of developing NODAT. © 2014 Elsevier Ireland Ltd.


Ieiri N.,Sendai Shakaihoken Hospital | Hotta O.,Sendai Shakaihoken Hospital | Sato T.,Sendai Shakaihoken Hospital | Taguma Y.,Sendai Shakaihoken Hospital
Clinical and Experimental Nephrology | Year: 2012

Background: Because of the well-established annual urinalysis screening system in Japan, the duration of nephropathy (DN) can be estimated in more than half of all patients with IgA nephropathy (IgAN). Treatment using a combination of tonsillectomy and steroid pulse (TSP) therapy has been reported as an effective method for obtaining clinical remission (CR), defined as negative hematuria and proteinuria, in IgAN patients. The present study aims to identify the correlation between DN and CR rate in IgAN patients treated by TSP therapy. Methods: We retrospectively investigated 830 IgAN patients who were followed up for 81.6 months after TSP therapy. DN could be estimated in 495 of the 830 patients. Results: The CR rate among patients with DN ≤36 months was 87.3% (295/338 patients). The CR rate among patients with DN of 37-84 months was 73.3% (63/86 patients), while that among patients with DN ≥85 months was 42.3% (30/71 patients). The CR rate among the remaining 335 patients in whom DN could not be estimated because of missing annual urinalysis results was 43.6% (146/335 patients). A multivariate Cox regression model using data from the former group of 495 patients showed that DN ≤36 months was a significant predictor of CR (hazard ratio 1.839; 95% confidence interval 1.410-2.398; P < 0.001). Conclusion: Shorter DN is associated with higher likelihood of clinical remission in IgAN patients treated by TSP therapy. © 2011 Japanese Society of Nephrology.


Tokodai K.,Sendai Shakaihoken Hospital | Amada N.,Sendai Shakaihoken Hospital | Kikuchi H.,Sendai Shakaihoken Hospital | Haga I.,Sendai Shakaihoken Hospital | And 2 more authors.
Tohoku Journal of Experimental Medicine | Year: 2013

New-onset diabetes after transplantation (NODAT) is a serious complication after kidney transplantation. Obesity was widely identified as a modifiable risk factor for NODAT. Body mass index (BMI) is the most frequently used diagnostic indication of obesity, and higher pretransplant BMI has been reported to be an independent risk factor of NODAT. However, the influence of posttransplant increase in BMI on the development of NODAT during outpatient follow-up has not been established. This is a single-centered retrospective study in Japan. We identified 158 consecutive patients who received living donor kidney transplantation in Sendai Shakaihoken Hospital from September 2000 to December 2009. Of these, 101 patients were included in this study. NODAT was defined based on the American Diabetes Association definitions. Fifteen patients developed NODAT with a median follow-up period of 27 (3-109) months. Of these 15 patients with NODAT, 13 patients were diagnosed after the first year of transplantation, with a median follow-up of 29 months, and 2 patients were diagnosed at 3 months after transplantation. Recipient age (HR: 1.06 [1.01-1.13]) and increase in BMI (HR: 1.12 [1.01-1.26]) proved to be independent risk factors of NODAT in multivariate logistic analysis after adjustments for pretransplant 2-hour OGTT level, pretransplant BMI, and use of tacrolimus. This is the first study showing the association between an increase in BMI and the development of NODAT. The increase in BMI might be a risk factor for NODAT. These findings underline the importance of routine BMI measurements in medical practice. © 2013 Tohoku University Medical Press.


Nakamura A.,Sendai Shakaihoken Hospital | Amada N.,Sendai Shakaihoken Hospital | Haga I.,Sendai Shakaihoken Hospital | Tokodai K.,Sendai Shakaihoken Hospital | Kashiwadate T.,Sendai Shakaihoken Hospital
Transplantation Proceedings | Year: 2014

Background The bioavailability of oral tacrolimus is influenced by enterocyte metabolism, which involves CYP3A and P-glycoprotein. Viral infection-induced intestinal inflammation damages the enterocytes and causes unfavorable elevations in blood tacrolimus levels in transplant recipients, which may lead to nephrotoxicity. Methods From May 2000 to May 2011, 56 renal transplant recipients receiving tacrolimus at our hospital suffered from infectious enteritis with diarrhea. We investigated the tacrolimus trough levels before and after the onset of enteritis and evaluated the influence of elevated tacrolimus trough levels on the rate of changes in serum creatinine levels. Results Elevated tacrolimus trough levels were observed in 52 recipients (93%) after the onset of diarrhea, and the mean value was 2.3 times higher than that before the onset of enteritis (P =.0175). Tacrolimus trough levels returned to their previous levels 2 weeks after the onset of enteritis, even in recipients with >2-fold increase, following dose adjustments. Serum creatinine levels did not significantly differ between recipients with >2-fold increase in tacrolimus trough levels and those with <2-fold increase in trough levels during a 6-month period after the onset of enteritis. Conclusions Elevations in the tacrolimus trough levels due to infectious enteritis with diarrhea can improve in ∼2 weeks by adjusting the tacrolimus dosage. Such temporary elevations in the tacrolimus trough levels may not produce serious nephrotoxicity even in recipients with remarkably elevated trough levels. © 2014 by Elsevier Inc. All rights reserved.


Tokodai K.,Sendai Shakaihoken Hospital | Amada N.,Sendai Shakaihoken Hospital | Kikuchi H.,Sendai Shakaihoken Hospital | Haga I.,Sendai Shakaihoken Hospital | And 2 more authors.
Transplantation Proceedings | Year: 2012

Background: Diabetic nephropathy is the most common cause of end-stage renal disease (ESRD) worldwide. However, data on renal transplantation outcomes in diabetic nephropathy among Japanese remain inadequate. This retrospective study was conducted to summarize our renal transplantation experience in diabetic ESRD patients. Methods: We retrospectively studied 462 patients who underwent kidney transplantation between 1989 and 2011, including 23 with diabetic ESRD (DM group) and 439 with nondiabetic ESRD (NDM group). We compared demographic and clinical variables between these 2 groups. Results: Mean age was higher in the DM group (48.0 vs 38.2 years; P <.001), and there was no significant difference in gender or donor source. The 1-, 3-, and 5-year graft survival rates in the DM and NDM groups were 100% vs 98.3% (ns), 82.4% vs 94.9% (P <.05), and 66.7% vs 90.3% (P <.01), respectively. The 1-, 3-, and 5-year patient survival rates were 95.0% vs 96.5% (ns), 88.2% vs 95.2% (ns), and 84.6% vs 92.9% (ns), respectively. One patient (4.3%) in the DM group and 6 (1.4%) in the NDM group died from cardiovascular disease during the follow-up period (ns). The incidence of rejection did not differ between the DM and NDM groups. There were no significant differences in the total infection rate or the urinary tract infection rate. Conclusions: Renal transplantation in diabetic ESRD patients yields good results in terms of patient survival and complications, suggesting that renal transplantation can be performed in these patients and should become a more established treatment option. © 2012 Published by Elsevier Inc.

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