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Toride, Japan

Shintani S.,Toride Medical Center
Journal of Clinical Neuroscience | Year: 2013

Outcomes, particularly survival, for home-care patients with neurologic impairments who receive artificial nutrition, such as home parenteral nutrition (HPN) or percutaneous endoscopic gastrostomy (PEG) feeding, remain unclear. The efficacy of tube feeding for life prolongation in elderly patients remains controversial. The aim of this study was to assess the survival of elderly patients with neurologic impairments after the start of HPN or PEG. We retrospectively evaluated 80 patients with neurologic impairments who had received home care before they died. They were divided into three groups according to feeding method: oral-intake group (n = 23), HPN group (n = 21) and PEG group (n = 36). The factors considered were: age; survival period after commencement of home care; swallowing function; serum albumin concentration; level of activities of daily living (ADL); and behavioral, cognitive and communication functions. Survival periods of the patients in the PEG (736 ± 765 days) and HPN (725 ± 616 days) groups were twice that of the self-feeding oral-intake group (399 ± 257 days) despite lower serum albumin concentration (for PEG patients), reduced swallowing function and cognitive function, and poorer levels of ADL at the start of home care. Almost all patients were incapable of deciding whether they should receive artificial nutrition due to dementia or poor comprehension. Physicians should provide clinical evidence to families before commencing PEG feeding or HPN and support their decisions to maintain the dignity of the patient. © 2012 Elsevier Ltd. All rights reserved. Source

Tomimitsu H.,Toride Medical Center | Ohta A.,Saitama University | Nagai M.,Saitama University | Nishina M.,Saitama University | And 2 more authors.
Modern Rheumatology | Year: 2016

Objectives: This study aimed to investigate the clinical characteristics of polymyositis/dermatomyositis (PM/DM) in Japan by analyzing data from the nationwide registration system.Methods: The data of the registration system in 2009 were analyzed to investigate patient numbers, sex, clinical symptoms, therapies, complications, and prognosis of PM/DM.Results: The total number of PM/DM cases was approximately 17,000, and the female/male sex ratio was 2.7:1. Almost all patients improved as a result of therapy, but many suffered from sequelae such as muscle weakness.Conclusions: The results characterize significant aspects of Japanese PM/DM patients. However, a further prospective survey is required to clarify the true epidemiology and natural history of PM/DM. © 2015 Japan College of Rheumatology. Source

Tanaka T.,Toride Medical Center | Maeda Y.,Toride Medical Center
Japanese Journal of Nephrology | Year: 2015

A 68-year-old woman visited JA Toride Medical Center with asymptomatic proteinuria. Bence Jones protein-λ was identified in her serum and urine samples, and subsequent bone marrow aspiration revealed multiple myeloma (MM). Simultaneous renal biopsy showed only minor glomerular abnormality and preserved interstitium. Since the clinical stage was not advanced, aggressive treatment was avoided. During the following six months, her renal function gradually deteriorated with sustained elevation of urine protein and β2 microglobulin excretion, although other routine blood tests yielded stable results. In contrast to the first renal biopsy, the second biopsy specimen exhibited findings suggestive of inflammatory cell infiltration associated with light chain deposition along the tubular basement membrane. However, her myeloma did not cause symptoms other than mild renal disorder and remained in the category of indolent myeloma. Therefore a moderate dose of steroid therapy according to the regimen of common interstitial nephritis was initiated and her renal function and urinary findings partially recovered. Subsequently, her condition was diagnosed as infiltration of plasma cells with positive λ-light chain deposition. Since direct infiltration of myeloma cells into the renal interstitium rarely causes renal failure especially at the initial stage, we did not conduct intensive chemotherapy with possible severe side effects. More intensive chemotherapy would have been administered if the patient had suffered from other organ damage. There are no reports of cases in whom steroid alone was effective against multiple myeloma, hence this case is of clinical significance in providing a treatment option for renal dysfunction caused by restricted infiltration of myeloma cells, especially for cases where intensive chemotherapy is contraindicated. Source

Ichijo M.,Tokyo Medical and Dental University | Ichijo M.,Red Cross | Iwasawa E.,Tokyo Medical and Dental University | Numasawa Y.,Tokyo Medical and Dental University | And 7 more authors.
American Journal of Neuroradiology | Year: 2015

BACKGROUND AND PURPOSE: Predicting response to rtPA is essential in the era of endovascular therapy for stroke. The purpose of this study was to elucidate prognostic factors of early neurologic improvement and long-term outcome with respect to the development and reversion of leptomeningeal collaterals in recanalization therapy after acute ischemic stroke. MATERIALS AND METHODS: We analyzed consecutive patients with proximal MCA occlusion treated with rtPA from 2007 to 2012 at 2 hospital stroke centers. All patients routinely underwent brain MR imaging before rtPA. To assess the reversion of collateral signs, we included patients who underwent follow-up MR imaging. We assessed the development and reversion of collaterals by using a combination of 2 MR imaging collateral markers, the hyperintense vessel sign and the posterior cerebral artery laterality sign. Early neurologic improvement was defined as a decrease in the NIHSS score of 10 or a score of 2 at 24 hours of treatment. RESULTS: Early neurologic improvement was observed in 22 of 48 eligible patients. The development of collaterals at arrival (15/22 versus 9/26, P<.042) was significantly associated with early neurologic improvement. Multivariate analysis adjusting for other variables showed that the development of collaterals at arrival (OR, 4.82; 95% CI, 1.34-19.98; P < .015) was independently associated with early neurologic improvement. Reversion of collaterals was significantly associated with successful recanalization (P < .001), and multivariate analysis showed that the reversion of collaterals was an independent prognostic factor of long-term functional outcome (OR, 5.07; 95% CI, 1.38-22.09; P < .013). CONCLUSIONS: Our results indicate that the development of leptomeningeal collaterals plays a crucial role in achieving early neurologic improvement, and reversion of collaterals predicts a favorable outcome via arterial recanalization after rtPA treatment for acute stroke. Source

Background Contrast-induced acute kidney injury (CI-AKI) is associated with adverse outcomes. However, the problem complicating CI-AKI relates to its definition. More than 30 definitions of AKI have been used in the literature. We examined the prevalence of CI-AKI according to three criteria. Prevalence of cardiovascular events according to each criterion was also investigated. Methods We studied 247 consecutive patients with acute myocardial infarction (66.7 ± 9.0 years, 189 males) who underwent primary percutaneous coronary intervention in our hospital. Three definitions of CI-AKI were applied: (i) traditional CI-AKI, (ii) CI-AKI derived from RIFLE criteria, (iii) CI-AKI derived from AKIN criteria. Cardiovascular events comprised in-hospital death, sudden death, cerebral infarction, heart failure, and acute coronary syndrome. Results Prevalence of CI-AKI was 27.1% (67/247) according to the traditional CI-AKI definition, 23.9% (59/247) according to the CI-AKI definition derived from RIFLE criteria, and 15.8% (39/247) according to the CI-AKI definition derived from AKIN criteria. Prevalence of cardiovascular events was 13.8% (34/247). Prevalence of cardiovascular events with and without CI-AKI was 19.4% (13/67) and 11.7% (21/180) according to the traditional CI-AKI definition (P = 0.13), 22.0% (13/59) and 11.2% (21/188) in the CI-AKI definition derived from RIFLE criteria (P = 0.035), and 35.9%(14/39) and 9.6% (20/208) according to the CI-AKI derived from AKIN criteria (P = 0.00001). Conclusion Prevalence of CI-AKI varies widely depending on the criteria used. The CI-AKI definition derived from AKIN criteria was the most effective predictor of cardiovascular events. © 2015 Published by Elsevier Ltd. Source

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