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Shinjuku, Japan

Yabe Y.,Tokyo Kosei Nenkin Hospital | Kojima T.,Nagoya University | Kaneko A.,Nagoya Medical Center | Asai N.,Nakatsugawa Municipal General Hospital | And 2 more authors.
Modern Rheumatology | Year: 2013

Objectives: Biologics have transformed the treatment of rheumatoid arthritis. Clinical remission is now the goal. We sought to verify whether the administration of tocilizumab - a biologic - can help to achieve current treatment goals. Methods: Using data from the Tsurumai Biologics Communication Registry for 122 patients treated with tocilizumab, we evaluated changes in DAS28-ESR at 12 months after initiation, and also evaluated remission rates defined using conventional and new Boolean-based remission criteria. We divided 50 patients who had received tocilizumab as a first-line treatment into two groups [disease duration at baseline of 12 months or less (≤12 M) and more than 12 months (>12 M)]. Results: At 12 months after initiation, there was no difference in DAS28-ESR, and remission rates based on the conventional criterion were also comparable (50 % in both groups). However, under the new criterion, remission was 50.0 % in the ≤12 M group against 12.5 % in the >12 M group (p = 0.0181). Among the individual components of the new remission criterion, the small proportion of patients in the >12 M group with a patient global assessment (PtGA) of ≤ 1 had a particularly strong influence on the remission rate for that group, but this component was not as important for the ≤ 12 M group. Conclusions: When used as a first-line biological drug for patients with early-stage RA (≤ 12 M), tocilizumab appears to provide high rates of remission under the Boolean-based remission criterion, which were strongly affected by the PtGA. © Japan College of Rheumatology 2012.

Otsubo T.,Tokyo Kosei Nenkin Hospital
Nihon rinsho. Japanese journal of clinical medicine | Year: 2012

It's very important to know how to use psychotropic medicine, especially selective serotonin reuptake inhibitors in pregnant women. Because between 14% and 23% of pregnant women will experience a depressive disorder while pregnant. In 2003, approximately 13% of women took an antidepressant at some point in pregnancy, a rate that has doubled since 1999. Both maternal depressive symptoms and antidepressant exposure are associated with fetal growth changes and shorter gestations, but the majority of studies that evaluated antidepressant risks were unable to control for the possible effects of a depressive disorder. Antidepressant use in pregnancy is well studied, but available research has not yet adequately controlled for other factors that may influence birth outcomes including maternal illness or problematic health behaviors that can adversely affect pregnancy.

Tsuda A.,Tokyo Womens Medical University | Nishimura K.,Tokyo Womens Medical University | Naganawa E.,Tokyo Womens Medical University | Otsubo T.,Tokyo Kosei Nenkin Hospital | Ishigooka J.,Tokyo Womens Medical University
International Journal of Psychiatry in Medicine | Year: 2014

Objective: Melatonin is effective in the prevention and treatment of delirium. Ramelteon has few adverse effects and higher affinity for MT1 and MT2 receptors than melatonin. The aim of the present study was to determine the efficacy of ramelteon in elderly patients with delirium caused by different primary diseases/conditions. Method: We treated 10 consecutive elderly patients having delirium with ramelteon. Results: Of the 10 patients, six showed improvement, and no marked adverse effects were observed. Conclusions: Our study suggested that ramelteon was a safe and useful alternative to melatonin for the treatment of delirium in elderly patients. Randomized, controlled studies are necessary to confirm the therapeutic benefits of ramelteon. © 2014, Baywood Publishing Co., Inc.

Kaneishi K.,Tokyo Kosei Nenkin Hospital
Palliative medicine | Year: 2013

Persistent hiccup can cause anorexia, weight loss, disabling sleep deprivation, anxiety, and depression. Therefore, relief of persistent hiccup is important for advanced cancer patients and their family. Most reports on this condition are case series reports advocating the use of baclofen, haloperidol, gabapentin, and midazolam. However, these medications are occasionally ineffective or accompanied by intolerable side effects. The sodium channel blocker lidocaine has been shown to be effective in treating a variety of disorders thought to involve neuropathic mechanisms. Intravenous administration of lidocaine is common but efficacy has also been reported for subcutaneous infusion. In advanced cancer patients, subcutaneous infusion is easy, advantageous, and accompanied by less discomfort. We report a case of severe and sustained hiccup caused by gastric cancer that was successfully treated with a continuous subcutaneous infusion of lidocaine (480 mg (24 ml)/day) without severe side effects.

Mizuno Y.,Tokyo Kosei Nenkin Hospital
Nihon Kokyūki Gakkai zasshi = the journal of the Japanese Respiratory Society | Year: 2011

An 83-year-old man had been prescribed clopidogrel for pontine infarction since 8 months previously, and had had a cough for the last 2 weeks of this period. Laboratory examinations on admission showed a marked increase in eosinophils and elevated serum immunoglobulin E levels. Chest radiography showed bilateral ground-glass opacities, mild reticulation, and interlobar pleural effusion in the minor fissure. After clopidogrel was discontinued his symptoms resolved, and his laboratory tests showed normal results. Bronchoalveolar lavage also showed an increase in eosinophils, and transbronchial biopsy revealed infiltration of eosinophils in the subepithelium of the bronchial mucosa. On the basis of these findings, we diagnosed eosinophilic pneumonia induced by clopidogrel. Reports on cases of lung diseases caused by anti-platelet drugs are rare. To the best of our knowledge, this case is the first report on clopidogrel-induced eosinophilic pneumonia.

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