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Sakata Y.,Saga Medical School | Tominaga K.,Osaka City University | Kato M.,Hokkaido University | Takeda H.,Hokkaido University | And 84 more authors.
BMC Gastroenterology | Year: 2014

Background: The incidence and severity of gastroesophageal reflux disease (GERD) in Japan tends to increase in elderly women. Rikkunshito (RKT), a traditional Japanese medicine, acts as a prokinetic agent and improves gastric emptying and gastric accommodation. Our previous prospective randomized placebo-controlled study showed that RKT combined with a standard-dose of rabeprazole (RPZ) significantly improved the acid-related dysmotility symptoms (ARD) in elderly patients with proton pump inhibitor (PPI)-refractory non-erosive reflux disease (NERD). This study aimed to evaluate clinical characteristics of elderly PPI-refractory NERD patients with ARD symptoms who responded to RKT.Methods: Two hundred forty-two patients with PPI-refractory NERD were randomly assigned to 8 weeks of either RPZ (10 mg/q.d.) + RKT (7.5 g/t.i.d.) (RKT group) or RPZ + placebo (PL group). Among them, 95 were elderly (≥65 years) with ARD (RKT group: n = 52; PL group: n = 43). We analyzed the changes using the 12 subscale score of frequency scale for the symptoms of GERD (FSSG) and 15 items of the Gastrointestinal Symptom Rating Scale at 4 and 8 weeks and compared the therapeutic efficacy between the 2 groups.Results: There were no marked differences in baseline demographic or clinical characteristics in the 2 groups except for rate of current smoking. The FSSG score (mean ± SD at 0, 4, and 8 weeks) in both the RKT (16.0 ± 7.0; 9.9 ± 8.4; 7.0 ± 6.4) and PL (15.1 ± 6.4; 10.9 ± 6.7, 11.1 ± 8.5) groups significantly decreased after treatment. However, the degree of improvement of total and ARD scores of FSSG after the 8-week treatment was significantly greater in the RKT group than in the PL group. Combination therapy with RKT for 8 weeks showed significant improvement in 3 subscale scores (abdominal bloating, heavy feeling in stomach and sick feeling after meals) of the ARD domain and 1 subscale score (heartburn after meals) of the reflux symptom domain.Conclusions: RKT may be useful for improving GERD symptoms in elderly PPI-refractory NERD patients with ARD. Thus, RKT was particularly effective for resolving postprandial GERD symptoms (heavy feeling in stomach, sick feeling, and heartburn after meals).Trial registration: (UMIN000005880). © 2014 Sakata et al.; licensee BioMed Central Ltd.


Ogawa H.,Kobe University | Park S.,Shizuoka Children Hospital | Matsumoto D.,Yaizu City General Hospital | Horikiri M.,Gunma Prefectural Cancer Center | And 2 more authors.
Japanese Journal of Plastic Surgery | Year: 2011

We report a suspected case of binderoid complete cleft lip/palate in which we performed cheiloplasty and columella reconstruction simultaneously. The patient has had a right cleft lip, alveolar cleft, defect of the columella and caudal portion of the nasal septum since birth. Midface hypoplasty, hypoterolism were also observed; however, other complications or intracranial abnormality were not monitored by CT scan. She seemed a good candidate for general anesthesia. At 3 months of age, surgical correction of the lip and columella was performed. The cheiloplasty was performed based on the rotation-advancement method and triangular flap on the white lip. The soft tissue of the columella was also reconstructed. The skin flap pedicled with the nasal tip was elevated, and the anterior wall of the columella was reconstructed. The right lateral wall of the columella was reconstructed with a vermilion flap from the non-cleft side. The left lateral wall of the columella was reconstructed with the C-flap of rotation-advancement cheiloplasty but no reconstruction of the cartilagenous structure of the nose was conducted. No delayed wound healing and complication occurred postoperatively. At 3 years after the surgery, the external nose appears slightly flat. However, the symmetry of the nostrils, nasal breathing, and the shape of the columella have been retained.


Shindoh J.,Yaizu City General Hospital | Shindoh J.,University of Tokyo | Niwa H.,Yaizu City General Hospital | Kawai K.,Yaizu City General Hospital | And 5 more authors.
Hepato-Gastroenterology | Year: 2011

Background/Aims: Severity of inflammation may be a risk factor for negative outcome in non-operative therapy of appendicitis. However, optimal screening test for predicting the pathological severity of appendicitis has not been established. Methodology: 632 consecutive patients who underwent appendectomy at a single institute were retrospectively reviewed. Clinical parameters are compared among the three pathological grades: simple (G1), gangrenous (G2), and perforated appendicitis (G3). The diagnostic power of inflammatory markers (WBC count and CRP concentration) in discriminating the advanced appendicitis from the milder one was evaluated. Results: CRP concentration was well correlated with the severity of appendicitis (p>0.0001), while WBC count showed only slight increase in advanced pa-thology (G1 vs. G2-G3). In receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) was remarkably higher in CRP (AUC 0.809) compared with that in WBC count (AUC 0.617), suggesting that CRP is a more sensitive test in discriminating the pathological severity of appendicitis. Multivariate analysis confirmed that CRP concentration >6.2mg/dL (OR: 5.12; 95% CI: 2.17-12.7) and diameter >12mm (OR: 4.33; 95% CI: 1.98-9.90) were strong predictive factors for advanced appendicitis. Conclusions: CRP concentration may be a potent objective predictor of pathological severity in appendicitis. Combination with the other diagnostic modalities may improve the diagnostic accuracy in predicting the severity of appendicitis. © H.G.E. Update Medical Publishing S.A.


Shindoh J.,Yaizu City General Hospital | Shindoh J.,University of Tokyo | Niwa H.,Yaizu City General Hospital | Kawai K.,Yaizu City General Hospital | And 5 more authors.
Journal of Gastrointestinal Surgery | Year: 2010

Background: Acute appendicitis has been reported to be managed with non-operative therapy at relatively high successful rate. However, risk factors for negative outcome have not been established. Method: Three hundred eighty consecutive patients who underwent initial therapy for suspected appendicitis were reviewed. They were divided into three groups: operation group, the group successfully managed with non-operative therapy (success group), and the group required surgical conversion (failure group). Preoperative clinical data were compared among the groups and risk factors for negative outcomes were investigated. Result: Thirteen patients were excluded due to contraindication for non-operative therapy. Of the remaining 367 patients, 143 patients (39.0%) were primarily treated with surgery, and 224 patients (61.0%) were initially managed with antibiotics. Among the 224 patients, 91 patients (40.6%) were refractory to antibiotics and converted to surgery after more than 24 h usage of antibiotics. Multivariate analysis revealed that elevated C-reactive protein (CRP) level (>4 mg/dL) and presence of appendicolith were significant risk factors for conversion. Morbidity rate showed no significant difference between the operative and failure groups. Conclusion: Elevated CRP concentration and appendicolith may predict the negative outcome in non-operative management. However, immediate appendectomy can possibly be avoided at least 24 h without increasing morbidity under the usage of antibiotics. © 2009 The Society for Surgery of the Alimentary Tract.


PubMed | Yaizu City General Hospital
Type: Journal Article | Journal: Hepato-gastroenterology | Year: 2012

Severity of inflammation may be a risk factor for negative outcome in non-operative therapy of appendicitis. However, optimal screening test for predicting the pathological severity of appendicitis has not been established.632 consecutive patients who underwent appendectomy at a single institute were retrospectively reviewed. Clinical parameters are compared among the three pathological grades: simple (G1), gangrenous (G2), and perforated appendicitis (G3). The diagnostic power of inflammatory markers (WBC count and CRP concentration) in discriminating the advanced appendicitis from the milder one was evaluated.CRP concentration was well correlated with the severity of appendicitis (p>0.0001), while WBC count showed only slight increase in advanced pathology (G1 vs. G2-G3). In receiver operating characteristic (ROC) curve analysis, the area under the curve (AUC) was remarkably higher in CRP (AUC 0.809) compared with that in WBC count (AUC 0.617), suggesting that CRP is a more sensitive test in discriminating the pathological severity of appendicitis. Multivariate analysis confirmed that CRP concentration >6.2mg/dL (OR: 5.12; 95% CI: 2.17-12.7) and diameter >12mm (OR: 4.33; 95% CI: 1.98-9.90) were strong predictive factors for advanced appendicitis.CRP concentration may be a potent objective predictor of pathological severity in appendicitis. Combination with the other diagnostic modalities may improve the diagnostic accuracy in predicting the severity of appendicitis.


PubMed | Yaizu City General Hospital
Type: Journal Article | Journal: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract | Year: 2010

Acute appendicitis has been reported to be managed with non-operative therapy at relatively high successful rate. However, risk factors for negative outcome have not been established.Three hundred eighty consecutive patients who underwent initial therapy for suspected appendicitis were reviewed. They were divided into three groups: operation group, the group successfully managed with non-operative therapy (success group), and the group required surgical conversion (failure group). Preoperative clinical data were compared among the groups and risk factors for negative outcomes were investigated.Thirteen patients were excluded due to contraindication for non-operative therapy. Of the remaining 367 patients, 143 patients (39.0%) were primarily treated with surgery, and 224 patients (61.0%) were initially managed with antibiotics. Among the 224 patients, 91 patients (40.6%) were refractory to antibiotics and converted to surgery after more than 24 h usage of antibiotics. Multivariate analysis revealed that elevated C-reactive protein (CRP) level (>4 mg/dL) and presence of appendicolith were significant risk factors for conversion. Morbidity rate showed no significant difference between the operative and failure groups.Elevated CRP concentration and appendicolith may predict the negative outcome in non-operative management. However, immediate appendectomy can possibly be avoided at least 24 h without increasing morbidity under the usage of antibiotics.

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