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Fueda Y.,Himeji Dokkyo University | Fueda Y.,Nara Institute of Science and Technology | Katayama T.,Himeji Dokkyo University | Sato T.,Nara Institute of Science and Technology | And 3 more authors.
Transactions of Japanese Society for Medical and Biological Engineering | Year: 2014

Intradialytic hypotension occurred in about 20 to 30% of treatments. Therefore, it is important to observe the variation of intravascular volume and blood pressure to prevent intradialytic hypotension during hemodialysis (HD). In this study, we constructed a mathematical model to understand the variation of intravascular volume in HD patients. Then, we examined the validity of the model. By applying this model, we proposed a method for identifying patients in need of pharmacotherapy to prevent intradialytic hypotension during HD. In 14 patients with end-stage renal disease (ESRD), we measured the variation of intravascular volume through blood volume monitoring (BVM) during HD. Then, we estimated the water movement rate, r, and the maximum excess volume in extravascular, VO. max, using nonlinear least-squares method. The relation of the mathematical model and the BVM value showed a high correlation. The correlation coefficient R (=0.95) could be used to detect patients in need of observation. Further, the relation of the maximum excess volume in extravascular, VO. max, and difference between body weight and dry weight showed also a high correlation. The model expressed correctly the variation of the intravascular volume. The correlation coefficient R of the mathematical model and the BVM value and the maximum excess volume in extravascular, VO. max were important parameters to manage HD. We proposed the mathematical model and new index to control HD efficiently. Source


Matsukage T.,Tokai University | Masutani M.,Hyogo College of Medicine | Yoshimachi F.,Aomori Prefectural Central Hospital | Takahashi A.,Takahashi Hospital | And 17 more authors.
Catheterization and Cardiovascular Interventions | Year: 2010

Objectives: The aim of this study was to evaluate the safety and effectiveness of a 0.010-inch guidewire and a balloon catheter for treatment of chronic total occlusion (CTO). Background: Pathological studies have shown that 60-70% of CTO lesions have microchannels of sizes equal to or less than 0.010 inch. Methods: The PIKACHU registry is a prospective, multicenter registry study. A 0.010-inch guidewire had to be used as the first guidewire to attempt to pass the CTO lesion. The primary endpoint was device success using a 0.010 system. Results: A total of 141 patients with 141 lesions were enrolled. The median duration of occlusion was 9 months (range 3-156). Average guiding catheter size was 5.8 ± 0.7 Fr. and TRI was 76.6%. CTOs were mostly between 10-20 mm long, observed in 53 occlusions. There were 107 lesions (75.9%) with bending of more than 45 degrees. Calcification was seen in 91 lesions (64.5%). A 0.010-inch guidewire was successfully passed through in 97 of 141 lesions (68.8%). A 0.010-inch guidewire compatible balloon catheter was passed in 87 of the 97 lesions (88.7%) and final PCI success was achieved in all the cases. The overall clinical success rate was 87.9% (124/141). No MACE or bleeding complications were observed. Conclusion: The PIKACHU registry data suggest that the 0.010-inch system is safe and practicable for treatment of CTO lesions. © 2010 Wiley-Liss, Inc. Source


Tamaki S.,Takai Hospital | Yamanaka Y.,Takai Hospital | Shimomura H.,Takai Hospital | Kawashima W.,Takai Hospital | Sasahira T.,Nara Medical University
Asian Journal of Oral and Maxillofacial Surgery | Year: 2011

This report is the case report of a 48-year-old woman who referred to our hospital complaining of a mass at the left maxillary tuberosity and slight trismus. CT and MRI imagings showed a tumor like image with bone absorption of the left maxillary tuberosity. Under general anesthesia, the lesion was excised. Histopathological examination showed low grade mucoepidermoid carcinoma. There is no sign of recurrence or metastasis of the tumor in 5 year after the surgery. © 2010. Source


Hironaka Y.,Nara Medical University | Morimoto T.,Takai Hospital | Motoyama Y.,Nara Medical University | Park Y.-S.,Nara Medical University | Nakase H.,Nara Medical University
Neurologia Medico-Chirurgica | Year: 2013

Surgical treatment for degenerative spinal disorders is controversial, although lumbar fusion is considered an acceptable option for disabling lower back pain. Patients underwent instrumented minimally invasive anterior lumbar interbody fusion (mini-ALIF) using a retroperitoneal approach except for requiring multilevel fusions, severe spinal canal stenosis, high-grade spondylolisthesis, and a adjacent segments disorders. We retrospectively reviewed the clinical records and radiographs of 142 patients who received mini-ALIF for L4-5 degenerative lumbar disorders between 1998 and 2010. We compared preoperative and postoperative clinical data and radiographic measurements, including the modified Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score for back and leg pain, disc height (DH), whole lumbar lordosis (WL), and vertebral wedge angle (WA). The mean follow-up period was 76 months. The solid fusion rate was 90.1% (128/142 patients). The average length of hospital stay was 6.9 days (range, 3-21 days). The mean blood loss was 63.7 ml (range, 10-456 ml). The mean operation time was 155.5 min (range, 96-280 min). The postoperative JOA and VAS scores for back and leg pain were improved compared with the preoperative scores. Radiological analysis showed significant postoperative improvements in DH, WL, and WA, and the functional and radiographical outcomes improved signif-cantly after 2 years. The 2.8% complication rate included cases of wound infection, liquorrhea, vertebral body fractures, and a misplaced cage that required revision. Mini-ALIF was found to be associated with improved clinical results and radiographic findings for L4-5 disorders. A retroperitoneal approach might therefore be a valuable treatment option. © 2013 by The Japan Neurosurgical Society. Source


Iijima S.,National Rehabilitation Center for Persons with Disabilities | Aida N.,Nagoya University | Ito H.,Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology | Endo H.,National Center for Geriatrics and Gerontology | And 9 more authors.
Geriatrics and Gerontology International | Year: 2014

The Japan Geriatrics Society published a revised version of its position statement regarding the end-of-life care for elderly patients, based on the overall consensus by the members of the ethics committee in 2012. This revision is intended to catch up with current changes of views on the end-of-life care for older people over the past decade. There are many suggestive items regarding the matter in this statement, and the authors believe it will be of specific guidance for those who are caring for older people in their final stage of life in the super-aged society. Also, the statement can be useful in many other countries, where aging of the population is not yet an urgent concern, but will be so in the future. We believe that this "position statement" can offer guidance in an ethical respect for those who are or will be engaged in end-of-life care for older people. We also hope that the release of the current statement provides an avenue for broader discussion in a society with an increasing aged population. © 2014 Japan Geriatrics Society. Source

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