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Orita S.,Chiba Rosai Hospital | Orita S.,Chiba University | Koshi T.,Seirei Sakura Citizen Hospital | Mitsuka T.,Social Insurance Funabashi Central Hospital | And 11 more authors.
BMC Musculoskeletal Disorders | Year: 2011

Background: One of the sources of knee pain in osteoarthritis (OA) is believed to be related to local chronic inflammation of the knee joints, which involves the production of inflammatory cytokines such as tumor necrosis factor alpha (TNF), interleukin (IL)-6, and nerve growth factor (NGF) in the synovial membrane, and these cytokines are believed to promote pathological OA. In the present study, correlations between proinflammatory cytokines in knee synovial fluid and radiographic changes and functional scores and pain scores among OA patients were examined. Methods. Synovial fluid was harvested from the knees of 47 consecutive OA patients, and the levels of TNF, IL-6, and NGF were measured using enzyme-linked immunosorbent assays. Osteoarthritic knees were classified using Kellgren-Lawrence (KL) grading (1-4). The Western Ontario and McMaster University Osteoarthritis Index (WOMAC) was used to assess self-reported physical function, pain, and stiffness. Results: TNF and IL-6 were detectable in knee synovial, whereas NGF was not. TNF was not correlated with the KL grade, whereas IL-6 had a significantly negative correlation. We observed differences in the correlations between TNF and IL-6 with WOMAC scores and their subscales (pain, stiffness, and physical function). TNFα exhibited a significant correlation with the total score and its 3 subscales, whereas IL-6 exhibited a moderately significant negative correlation only with the subscale of stiffness. Conclusions: The present study demonstrated that the concentrations of proinflammatory cytokines are correlated with KL grades and WOMAC scores in patients with knee OA. Although TNF did not have a significant correlation with the radiographic grading, it was significantly associated with the WOMAC score. IL-6 had a significant negative correlation with the KL grading, whereas it had only a weakly significant correlation with the subscore of stiffness. The results suggest that these cytokines play a role in the pathogenesis of synovitis in osteoarthritic knees in different ways: TNFα is correlated with pain, whereas IL-6 is correlated with joint function. © 2011 Orita et al; licensee BioMed Central Ltd.


Seki N.,National Hospital Organization | Matsumoto T.,Social Insurance Funabashi Central Hospital | Fukazawa M.,Social Insurance Funabashi Central Hospital
Hormone and Metabolic Research | Year: 2015

The aim of the study was to examine the relationship between the brain natriuretic peptide (BNP) level and progression or remission of diabetic nephropathy with microalbuminuria for 3 years. The subjects were 100 Japanese type 2 diabetes mellitus outpatients with microalbuminuria. Associations between metabolic parameters at baseline [HbA1c, systolic blood pressure (SBP), urine albumin-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), and BNP] and the progression or remission of diabetic nephropathy were examined for 3 years. A total of 83 patients were examined at the end of the 3-year period, including 17 with remission to normoalbuminuria, 47 with continuing microalbuminuria, and 19 with progression to macroalbuminuria. HbA1c, ACR, and BNP differed significantly among the 3 groups (p=0.024, p<0.001, p=0.002, respectively). Among baseline factors, HbA1c and BNP were significant predictors of the percentage increase in ACR for 3 years in multiple linear regression analysis (β=0.259, p=0.02; β=0.299, p=0.007, respectively). In multivariate logistic regression analysis, HbA1c and ACR were independently associated with progression of diabetic nephropathy (p=0.008, p=0.023, respectively), and ACR and BNP were independently associated with remission of diabetic nephropathy (p=0.029, p=0.012, respectively). ROC curve analysis gave a cutoff value for BNP of 14.9 pg/ml for prediction of remission of diabetic nephropathy (p=0.016). The BNP level has a relationship with diabetic nephropathy and a low BNP level predicts remission of diabetic nephropathy. Therefore, monitoring of BNP can play an important role in management of diabetic nephropathy. © Georg Thieme Verlag KG Stuttgart, New York.


Sakurai Y.,Social Insurance Funabashi Central Hospital | Uchida M.,Social Insurance Funabashi Central Hospital | Mimura F.,Social Insurance Funabashi Central Hospital
Japanese Journal of Anesthesiology | Year: 2014

Background : To test safety and efficacy of ORT (oral rehydration therapy), we compared an ORT group with an intravenous infusion (iv) group by gastric fluid (volume and pH) obtained by endoscope and gastric ultrasonography examination. Methods : Twenty six patients scheduled for endoscopic surgery were assigned to an ORT group or an iv group by standardized clinical path. After gastric ultrasonography examinations to calculate CSA (cross sectional area) of gastric antrum, general anesthesia was induced. Immediately after anesthesia induction, gastric fluid was obtained by endoscopy, and its volume and pH were measured Results : Fifteen and eleven patients were assigned to ORT group and iv group, respectively. In ORT group, CSA was median 1.9 cm2 (95%CI : 1.8-2.6 cm2), gastric volume was median 11 ml (95%CI : 8-18 ml) and pH was median 3.6 (range : 1.2-8.8), and in iv group CSA was median 1.8 cm 2 (95%CI : 1.6-2.7 cm2), gastric volume was median 4 ml (95%CI : 3-12 ml), and pH was median 3.1 (range : 1.2-7.2). There was no significance between the two groups. Conclusions : Gastric volume in ORS group was not smaller compared with that in iv group, and there was no significant difference in pH between the groups.


Sakurai Y.,Social Insurance Funabashi Central Hospital | Uchida M.,Social Insurance Funabashi Central Hospital | Aiba J.,Social Insurance Funabashi Central Hospital | Mimura F.,Social Insurance Funabashi Central Hospital | And 2 more authors.
Japanese Journal of Anesthesiology | Year: 2014

Background : We investigated whether sugammadex could reverse neuromuscular blockade induced by rocuronium in patients for cesarean delivery treated with magnesium sulfate preoperatively. Methods : Twenty-three pregnant women received general anesthesia induced with thiopental and rocuronium. They were maintained by nitrous oxide, oxygen and sevoflurane GOS before delivery and after delivery by GOS, midazolam, and propofol. After the surgery, the patients with two or more counts of train-offour (TOF), the moderate block group were classified into Mg (-) M and Mg (+) M, depending whether magnesium sulfate had been injected or not, and sugammadex 2 mg • kg-1 was administered to both groups. Patients with PTC 2 or more, the profound block group, were classified into Mg (-) P or Mg (+) P and sugammadex 4 mg • kg-1 was administered to both groups. Recovery time was defined as the time required to reach TOFR 0.9 or more after the injection of sugammadex. Results : Median recovery times of the Mg (-) M, the Mg (-) P, the Mg (+) M, and the Mg (+) P were 63 seconds (range : 26-130, N=7), 127 seconds (range : 63-228, N=7), 104 seconds (range • 67-133, N=5), and 142 seconds(range : 57-209, N=4), respectively. Conclusions : Sugammadex could reverse rocuronium-induced neuromuscular blockade in a doseresponse manner even in the patients treated with magnesium sulfate.


Seki N.,National Hospital Organization | Nishimura M.,National Hospital Organization | Matsumoto T.,Social Insurance Funabashi Central Hospital | Fukazawa M.,Social Insurance Funabashi Central Hospital | Kenmochi T.,National Hospital Organization
Journal of Diabetes and its Complications | Year: 2013

Aims: We examined the relationship between the brain natriuretic peptide (BNP) level and renal function in diabetic nephropathy with microalbuminuria. Methods: The subjects were 97 Japanese type 2 diabetes mellitus outpatients with microalbuminuria. Associations between the annual rate of decline in estimated glomerular filtration rate (eGFR) and various metabolic parameters at baseline (BMI, systolic blood pressure, HbA1c, LDL cholesterol, urine albumin-creatinine ratio, BNP and eGFR) were examined. Results: Among the baseline factors, eGFR and BNP had significant associations with the annual rate of decline in eGFR in Pearson correlation analysis (r = 0.295, p = 0.003; r = 0.223, p = 0.028, respectively). Multiple linear regression analysis also showed the significance of baseline eGFR and BNP as independent predictors of renal function (β = 0.340, p = 0.001; β = 0.278, p = 0.005, respectively). In multivariate logistic regression analysis, eGFR and BNP were independently associated with the risk of a decline in GFR (p = 0.003, p = 0.011, respectively). ROC curve analysis showed a cutoff value of BNP is 17.0 pg/mL for predicting a decline in GFR. Conclusions: The BNP level at baseline is an independent predictor of the annual rate of decline in eGFR. Therefore, monitoring of BNP can play an important role in management of diabetic nephropathy. © 2013 Elsevier Inc.


Higo M.,Social Insurance Funabashi Central Hospital | Sato T.,Social Insurance Funabashi Central Hospital | Komatsu T.,Social Insurance Funabashi Central Hospital | Takahashi K.,Social Insurance Funabashi Central Hospital
Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology | Year: 2015

Adenomatoid odontogenic tumors (AOTs), relatively uncommon benign lesions of odontogenic epithelial origin, are categorized into three clinicopathological variants: follicular, extrafollicular, and peripheral. We present a rare case of follicular AOT with an impacted tooth and a large calcified mass. A 13-year-old girl was referred by her orthodontist for evaluation of the delayed eruption of a left mandibular lateral incisor and a radiopaque mass of the anterior mandible. Computed tomography showed an odontoma-like radiopaque mass adjacent to the crown of the impacted left mandibular lateral incisor inside the radiolucent area. The lesion was enucleated totally as one mass with the unerupted tooth under general anesthesia. The histopathologic findings, such as the cuboidal or columnar epithelial cells forming duct-like or rosette-like structures and intercellular droplets of amorphous eosinophilic material, corroborated the AOT characteristics reported in the literature. However, the large calcified mass was a rare finding in follicular AOT. The current case of AOT was difficult to distinguish from the more common forms of odontogenic lesions. There have been no signs of recurrence of the AOT 14 months postoperatively. © 2013 Asian AOMS, ASOMP, JSOP, JSOMS, JSOM, and JAMI.


Sakurai Y.,Social Insurance Funabashi Central Hospital | Uchida M.,Social Insurance Funabashi Central Hospital | Aiba J.,Social Insurance Funabashi Central Hospital | Mimura F.,Social Insurance Funabashi Central Hospital | And 2 more authors.
Japanese Journal of Anesthesiology | Year: 2014

Background : Rapid onset of a muscle relaxant is required for general anesthesia with rapid sequence induction technique. Although a high dose of rocuro-nium was demonstrated to achieve the rapid onset in non-pregnant persons, it is still unknown whether this is true in women during late pregnancy. The purpose of this study is to compare the onset time of high dose rocuronium between pregnant and non-pregnant women. Methods : Ten pregnant women undergoing cesarean delivery and 10 age, height, and body weightmatched non-pregnant women were enrolled in the study. Neuromuscular function was continuously assessed by twitch response with acceleromyography immediately after induction of general anesthesia with intravenous injection of thiopental (4-5 mg • kg -1) and rocuronium (0.9 mg • kg-1). Onset time of muscle relaxation defined by the time from rocuronium bolus injection to complete absence of twitch height, was measured. Results : The onset time of rocuronium in pregnant women was significantly shorter than that in nonpregnant women (42 ±9 seconds vs. 56 ± 10 seconds ; P=0.0039, unpaired t-test). Conclusions : The onset time of high dose of rocuronium in pregnant women was significantly shorter than that of non-pregnant women.


PubMed | Teikyo University, Social Insurance Funabashi Central Hospital and University of Toyama
Type: | Journal: TheScientificWorldJournal | Year: 2015

The high incidence of tumor recurrence following transurethral resection (TUR) represents a major problem encountered in the management of bladder cancer. This study examined the efficacy of intravesical chemotherapy in superficial bladder cancer. We retrospectively analyzed 90 Japanese cases with low-grade superficial transitional cell carcinoma (stage T1, grades 1 and 2) who were rendered tumor-free by TURBT (TUR of bladder tumor) and who thereafter were treated with or without intravesical chemotherapy. Among them, instillation was terminated in 2 patients due to adverse effects (severe but reversible chemical cystitis). Remaining 88 patients were divided into 2 groups according to therapy: the TURBT-only group (n = 46), defined as patients treated with TURBT alone, and the Instillation group (n = 42), defined as patients treated with weekly intravesical instillation therapies using epirubicin plus Ara-C. Recurrence-free rate was significantly higher in the Instillation group than in the TURBT-only group (p = 0.02, HR = 0.457). The 5-year recurrence-free rate was 58.5% for the Instillation group and 38.6% for the TURBT-only group. Our instillation schedule represents the most intensive regimen among previously reported therapies and resulted in a 54.3% decrease in incidence of tumor recurrence. We believe that the results of this study could provide useful information on management of bladder cancer.


PubMed | Social Insurance Funabashi Central Hospital
Type: Case Reports | Journal: Internal medicine (Tokyo, Japan) | Year: 2013

A woman with rheumatoid arthritis (RA) experienced glottic stenosis approximately two months after switching from etanercept to tocilizumab. Cricoarytenoid joint (CAJ) arthritis due to RA was diagnosed. An awake tracheostomy saved the relievable airway, and the administration of methylprednisolone and infliximab ameliorated the flare-up and glottic stenosis. A follow-up examination revealed the recovery of the patients normal voice and good control of RA with infliximab and methotrexate. Although general physicians do not frequently encounter patients with symptomatic CAJ arthritis, this condition should be considered as it can be life-threatening. Therefore, when detected, it should be diagnosed and treated immediately.


PubMed | National Hospital Organization and Social Insurance Funabashi Central Hospital
Type: Journal Article | Journal: Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme | Year: 2015

The aim of the study was to examine the relationship between the brain natriuretic peptide (BNP) level and progression or remission of diabetic nephropathy with microalbuminuria for 3 years. The subjects were 100 Japanese type 2 diabetes mellitus outpatients with microalbuminuria. Associations between metabolic parameters at baseline [HbA1c, systolic blood pressure (SBP), urine albumin-creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), and BNP] and the progression or remission of diabetic nephropathy were examined for 3 years. A total of 83 patients were examined at the end of the 3-year period, including 17 with remission to normoalbuminuria, 47 with continuing microalbuminuria, and 19 with progression to macroalbuminuria. HbA1c, ACR, and BNP differed significantly among the 3 groups (p=0.024, p<0.001, p=0.002, respectively). Among baseline factors, HbA1c and BNP were significant predictors of the percentage increase in ACR for 3 years in multiple linear regression analysis (=0.259, p=0.02; =0.299, p=0.007, respectively). In multivariate logistic regression analysis, HbA1c and ACR were independently associated with progression of diabetic nephropathy (p=0.008, p=0.023, respectively), and ACR and BNP were independently associated with remission of diabetic nephropathy (p=0.029, p=0.012, respectively). ROC curve analysis gave a cutoff value for BNP of 14.9pg/ml for prediction of remission of diabetic nephropathy (p=0.016). The BNP level has a relationship with diabetic nephropathy and a low BNP level predicts remission of diabetic nephropathy. Therefore, monitoring of BNP can play an important role in management of diabetic nephropathy.

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