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Tochigi, Japan

Mashiko T.,Jichi Medical University | Anno T.,Tochigi Medical Center | Arai F.,Jichi Medical University | Watanabe E.,Jichi Medical University
Neurological Surgery

Cerebrospinal fluid shunting is a surgical treatment alternative for hydrocephalus. In general, ventriculoperitoneal (VP) and lumboperitoneal (LP) shunts have been widely practiced as standard procedures. However, these procedures are difficult because the shunt passer often rotates unintentionally. Therefore, we developed a simple device that prevents shunt passer rotation and termed it a "shunt passer-clamp" (SP-C). This device consists of two parts: the first part is the body with a hole through which the passer goes and a "female" screw perpendicular to the hole. The second part is a "male" screw set to the body. The surgeon can attach the SP-C to the shunt passer without the requirement for remodeling. We employed a SP-C for 14 consecutive shunt surgeries and received favorable feedback from the surgeons. Handling was considered "easy" in all cases. The surgical duration was significantly shorter than that if the SP-C was not employed. We conclude that our specially designed SP-C is relatively effective. Source

Fukuda T.,Nihon University | Watanabe H.,Tochigi Medical Center | Ido S.,Nihon University | Shiragami M.,Nihon University
Journal of Pharmaceutical Policy and Practice

Objectives: Do antimicrobial stewardship programs (ASPs) contribute to reduction of antimicrobial therapy costs in Japanese community hospitals? To answer this health economic question, a before-after comparative two-year trial in a community hospital in the country was designed. Methods: The study was conducted at National Hospital Organization Tochigi Medical Center, a community hospital with 429 beds. We compared six-month period before-ASP (January 2010 to June 2010) and 24-month period after ASP (July 2010 to June 2012) in primary and secondary outcome measures. Three medical doctors, three pharmacists and two microbiology technologists participate in the ASPs. The team then provided recommendations based on the supplemental elements to primary physicians who prescribed injectable antimicrobials. Prospective audit with intervention and feedback was applied in the core strategy while dose optimization, de-escalation and recommendations for alternate agents and blood cultures were applied in the supplemental elements. The primary outcome was measured by the antimicrobial therapy costs (USD per 1,000 patient-days), while the secondary outcomes included the amount of antimicrobials used (defined daily doses per 1,000 patient-days), sensitivity rates (%) of Pseudomonas aeruginosa (P. aeruginosa) to Meropenem (MEPM), Ciprofloxacin (CPFX) and Amikacin (AMK), length of stay (days) and detection rates (per 1,000 patient-day) of methicillin-resistant Staphylococcus aureus (MRSA) and extended spectrum beta-lactamase-producing organisms (ESBLs) through blood cultures. Results: In the study, recommendations were made for 465 cases out of 1,427 cases subject to the core strategy, and recommendations for 251 cases (54.0%) were accepted. After ASP, the antimicrobial therapy costs decreased by 25.8% (P = 0.005) from those before ASP. Among the secondary outcomes, significant changes were observed in the amount of aminoglycosides used, which decreased by 80.0% (P < 0.001) and the detection rate of MRSA, which decreased by 48.3% (P < 0.001). Conclusions: The study suggested the possibility that ASPs contributed to the reduction of the antimicrobial therapy costs in a community hospital with 429 beds. © 2014 Fukuda et al. Source

Toyoda S.,Dokkyo Medical University | Inami S.,Dokkyo Medical University | Kato T.,Tochigi Medical Center | Node K.,Saga University | Inoue T.,Dokkyo Medical University
American Journal of the Medical Sciences

Background: It is unclear whether thiazide diuretics (TZs) or calcium channel blockers (CCBs) are more effective as add-on therapy to angiotensin receptor blockers (ARBs) in controlling hypertension. Because TZs are a rational choice in salt-sensitive hypertension, patients with high salt intake might preferentially benefit from ARB/TZ over ARB/CCB combination therapy. Methods: Hypertensive patients who failed to reach blood pressure goals despite treatment with ARBs alone were randomly assigned to receive either ARB/TZ or ARB/CCB combination therapy. Estimated daily sodium intake was calculated from spot urine values of sodium and creatinine. Results: Blood pressure was measured at baseline, and at 4, 8 and 12 weeks after starting combination therapy. For all study patients (n 87), diastolic blood pressure reduction was greater in patients receiving ARB/CCB treatment. However, in the 37 patients with a baseline estimated daily salt intake greater than 10 g and baseline systolic blood pressure (SBP) ranging from 150 to 200 mm Hg, SBP was lower (P < 0.05) and SBP reduction was greater (P < 0.05) 4 weeks after starting combination therapy in those receiving ARB/TZ treatment. In the 31 patients whose estimated daily salt intake increased at 12 weeks compared with baseline, SBP at 12 weeks was lower in those receiving ARB/TZ treatment (P < 0.05). Conclusions: Estimated daily salt intake is a useful tool for guiding antihypertensive therapy and should be measured repeatedly during the therapeutic course. © 2015 by the Southern Society for Clinical Investigation. Source

Kato T.,Tochigi Medical Center
IRYO - Japanese Journal of National Medical Services

The center of the central biological clock exists in the supra-chaiasmatic nucleus in the hypothalamus. In addition to the central clock, the peripheral clock exists in many organs and cells including heart and vessels, cardiomyocytes, vascular endothelial cells, and smooth muscle cells. The peripheral clock has also intrinsic biological circadian rhythm as well as the central clock. Not only dyssynchrony between the internal clock and external stimuli, but also phase disparity between the central and peripheral clocks could induce myocardial infarction through disorders such as blood pressure, heart rate,coagulation system, and fibrinolytic system. In this review, I will discuss a paradigm shift in association with biological clock and circadian rhythm for the prevention and treatment of myocardial infarction. © 2014, Japanese Society of National Medical Services. All rights reserved. Source

Ishikawa T.,Tochigi Medical Center | Sakai M.,Tochigi Medical Center | Tashiro M.,Tochigi Medical Center | Takei S.,Saitama Municipal Hospital | Fujimine T.,Toda E.N.T. Clinic
Practica Oto-Rhino-Laryngologica

Tetanus is a serious infection caused by the neurotoxin which is produced by Clostridium tetani. Its symptoms may progress rapidly and sometimes can be fatal, so we have to make a diagnosis and treat early. To make a diagnosis, the detection of the bacterium is important, but it is rarely possible. In many cases, we identify tetanus mostly from the history of injury and the symptoms. We report herein on two cases of tetanus without injury. The first case, a 78-year-old woman who had undergone a left submandibular glandectomy and had hypoglossal nerve paralysis, visited us with the chief complaint of dysphagia. She developed laryngospasm four days later and a tracheotomy was required. We diagnosed tetanus in the third stage, and we transferred her to a tertiary medical facility. The other case, a 68-year-old woman visited us with the chief complaints of dysphagia, neck pain, and trismus. We started treatment, and she was cured. We have to bear in mind that there are a few cases of tetanus in which the patients have no visible injury. Source

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