1.Two Cases of Poststroke Hemiplegic Patients Whose Gate Ability Was Improved by Using Twister Orthoses
Sayaka ADACHI ; Keiko FURUKAWA ; Sayaka IKEDA ; Norihiko KODAMA ; Kenji MATSUMOTO ; Kazuhisa DOMEN
The Japanese Journal of Rehabilitation Medicine 2014;51(12):799-802
Twister orthoses are used to correct in-toeing and out-toeing, and consist of a pelvic band, a twister cable, and an ankle-foot orthosis (AFO). The twister cable is made of spiral coiled springs and connects the pelvic band with the AFO. Twister orthoses are used for children with lower limb paralysis who in many cases present with a rotation deformity of the hip joint ; however, their use in adults has not yet been reported. We report our experience treating two cases of adult poststroke hemiplegic patients whose gate ability was improved by using twister orthoses.
2.Identification of Acupuncture Indications and Evidence-based Medicine
Etsuko INOUE ; Si YU ; Naomichi SHIMIZU ; Kaoru ITOU ; Yuki MENJO ; Qiang LI ; Mitsuru TANAKA ; Kazuhisa IKEDA ; Toshiyuki SHICHIDO ; Kenji KAWAKITA
Journal of the Japan Society of Acupuncture and Moxibustion 2004;54(1):72-86
To identify indications for acupuncture treatment, we examined certain evidence-based medicine (EBM) practices by acupuncture/moxibustion clinicians who are novices in this field and identified problems and solutions from the perspective of an acupuncture/moxibustion clinician.
We collected cases of lumbago, shoulder disorders and strokes from the literature, and critically assessed these reports. We also investigated Cochrane Library's acupuncture/moxibustion reviews and evaluated the quality of domestic studies using randomized controlled trials and controlled clinical trials (RCT/CCT). Simultaneously, one of the authors evaluated her own clinical reports in light of EBM.
As a result, acupuncture/moxibustion treatments showed promise for treating lumbago and shoulder disorders, but the higher the quality of studies, the lower the effect of treatment after stroke. According to research by the Cochrane Library (as of issue 1, 2003), the effects of acupuncture/moxibustion was measured only for cases of idiopathic headache but those for other disorders were measured more severely. In Japan, RCT started as early as the 1960 s, but the studies were sluggish and high quality studies were not produced until the late 1990 s.
We presented problems of RCT assessment score, the gap between RCT designs and actual clinical scenes, and the difficulty of masking at the bed-side. To contribute to the accumulation of more evidence-based data, it would be desirable for clinicians to acquire EBM methods, consider clinical problems and collaborate positively with investigators in the field.
3.Cost-effectiveness Analysis of Pregabalin for Treatment of Peripheral Neuropathic Pain
Shunya IKEDA ; Setsuro OGAWA ; Toyoshi HOSOKAWA ; Kazushige MURAKAWA ; Nigishi HOTTA ; Shinichi KONNO ; Kazuhisa TAKAHASHI ; Shinichi KIKUCHI ; Kazuo HANAOKA ; Makoto KOBAYASHI
Japanese Journal of Pharmacoepidemiology 2011;16(1):1-9
This study aimed to estimate the cost-effectiveness of pregabalin treatment for neuropathic pain.
Design:Long-term simulations based on state transition models.
Methods:We examined the cost-effectiveness of pregabalin for treatment of three common peripheral neuropathic pains, postherpetic neuralgia(PHN), painful diabetic peripheral neuropathy(DPN), and radiculopathy, using the incremental cost-effectiveness ratio(ICER). We used quality-adjusted life years(QALYs)as an index of effectiveness, and also estimated medical costs. For PHN and DPN, we constructed state transition models comprising two states, with and without pregabalin treatment, and performed 52-week simulations. The pain scores reported in Japanese phaseIII studies were used to set patients' weekly pain scores. The results of utility surveys conducted overseas were used as utility scores, while values randomly sampled from probability distributions were used to set weekly pain scores and drop-out rates. In base-case analyses, we performed 1000 1st-order Monte Carlo simulations using 1000 values randomly sampled from probability distributions, and calculated QALYs and medical costs for 52 weeks for each group. For radiculopathy, the ICER was calculated from changes in QALYs for 12 weeks reported overseas and medical costs estimated separately for the identical period.
Results:The ICERs for PHN, DPN, and radiculopathy were 1,116,886 Yen/QALY, 1,100,420 Yen/QALY, and 1,095,943 Yen/QALY, respectively, which were well below the upper limits of ICER ranges for treatments considered cost-effective. There were no cases in which ICERs obtained from scenario and sensitivity analyses differed significantly.
Conclusion:Pregabalin was shown to be cost-effective treatment for neuropathic pain.
4.Hemolytic Anemia after Mitral Valve Surgery
Yuki Kuroda ; Kenji Minakata ; Kazuhiro Yamazaki ; Hisashi Sakaguchi ; Shingo Hirao ; Shinya Takimoto ; Kazuhisa Sakamoto ; Tomohiro Nakata ; Tadashi Ikeda ; Ryuzo Sakata
Japanese Journal of Cardiovascular Surgery 2016;45(2):67-72
Objective : The aim of this study is to describe a series of patients undergoing reoperation due to hemolytic anemia after mitral valve surgery and assess the mechanisms and surgical outcomes. Methods : Between 2009 and 2014, we performed redo mitral valve surgery in 11 patients who had refractory hemolytic anemia after mitral valve surgery at Kyoto University Hospital. The mean age of the patients was 72.2±6.8 years old, and there were 5 men. Results : Preoperative echocardiography demonstrated that only 3 patients had ≥ grade 3 mitral regurgitation (MR), the rest of the patients had only mild to moderate MR. The mechanisms of severe hemolysis included paravalvular leakage (PVL) after mitral valve replacement (MVR) in 8 patients, structural valve deterioration (SVD) after MVR using a bioprosthesis in one, and residual/recurrent mitral regurgitation after mitral valve plasty (MVP) in two. All the patients except one (re-MVP) underwent MVR. The mean interval between previous operation and current operation was 14.1±9.4 years in post-MVR cases, and 2.0±1.9 years in post-MVP cases. There were three late deaths, one of which was due to cardiac death (exacerbation of heart failure due to pneumonia). There was one patient who required re-MVR for recurrent hemolysis due to PVL after MVR. Conclusion : Although hemolytic anemia after mitral valve surgery is rare, it often requires reoperation regardless of the degree of MR at late follow-up period. Thus, patients after mitral valve surgery should be carefully followed-up.
5.Cardiovascular Surgery in Patients with Connective Tissue Disease
Shigeki Koizumi ; Kenji Minakata ; Kazuhiro Yamazaki ; Hisashi Sakaguchi ; Kyokun Uehara ; Kazuhisa Sakamoto ; Hiroomi Nishio ; Tomohiro Nakata ; Tadashi Ikeda ; Ryuzo Sakata
Japanese Journal of Cardiovascular Surgery 2017;46(3):101-106
Background : Connective tissue disease (CTD) is an idiopathic autoimmune disorder which causes systemic chronic inflammation. Inflammation causes various cardiovascular diseases. Systemic steroid use, which is usually the sole treatment for CTD, also causes arteriosclerosis. Although cardiovascular surgery is often necessary in patients with CTD, preexisting multiple organ dysfunction related to CTD, in addition to systemic administration of steroids or other immunosuppressants, is thought to increase the risk of surgery. However, little is known about how the disease process of CTD influences early and late cardiovascular surgery outcomes. Methods : To better understand these issues, we reviewed 31 patients with CTD (study group) and compared their outcomes to those of other patients (control group) who underwent cardiovascular surgery at our institution between April 2008 and November 2013. Results : There were 26 women and 5 men, and the average age was 64.4±16.7 years. CTD types included rheumatoid arthritis in 7 patients, systemic lupus erhythematosus in 6, aortitis syndrome in 6, polymyalgia rheumatica in 3, scleroderma in 3, polymyositis in 3, and others. The procedures included 10 valve cases, 10 coronary artery bypass grafting (CABG) or CABG-valve combination cases, and 11 isolated or complicated thoracic aortic surgery cases. Prior to undergoing these procedures, 24 patients (77.4%) were treated with steroids and/or immunosuppressant, and 6 patients had been diagnosed with interstitial pneumonia in the study group. Moreover, the rate of peripheral artery disease and carotid artery stenosis in the study group was significantly higher than that in the control group. There were no perioperative deaths in the study group. There were no significant differences in terms of major complications such as ischemic events, infection, acute kidney injury, lung injury, and others between the groups. We conducted a follow-up survey for the study group with an average period of 27.8±16.0 months. During the follow-up period, there were 4 late deaths. In addition, 8 patients required readmission, 6 for cardiovascular events and 2 for poor wound healing. All the survivors in the study group showed improved cardiac function and were in the NYHA functional class I and II. Conclusion : Cardiovascular surgery for patients with CTD can provide acceptable early and mid-term results.
6.Improvement of Bronchial Sensitivity by Spa Therapy in Patients with Asthma.
Fumihiro MITSUNOBU ; Takashi MIFUNE ; Kazuhiro KAJIMOTO ; Satoshi YOKOTA ; Yoshiro TANIZAKI ; Koji OCHI ; Hideo HARADA ; Satoru IKEDA ; Kazuhisa TAKETA
The Journal of The Japanese Society of Balneology, Climatology and Physical Medicine 1995;58(4):241-248
7.Spa Therapy and Function of Adrenocortical Glands in Patients with Steroid-Dependent Intractable Asthma(SDIA). Relatoinship to clinical asthma type, patient age, and clinical efficacy.
Takashi MIFUNE ; Fumihiro MITSUNOBU ; Yasuhiro HOSAKI ; Satoshi YOKOTA ; Yoshiro TANIZAKI ; Koji OCHI ; Hideo HARADA ; Satoru IKEDA ; Kazuhisa TAKETA
The Journal of The Japanese Society of Balneology, Climatology and Physical Medicine 1996;59(3):133-140
8.Spa Therapy for Patients with Respiratory Disease from Distant Areas.
Yasuhiro HOSAKI ; Takashi MIFUNE ; Fumihiro MITSUNOBU ; Satoshi YOKOTA ; Yoshiro TANIZAKI ; Koji OCHI ; Hideo HARADA ; Satoru IKEDA ; Kazuhisa TAKETA
The Journal of The Japanese Society of Balneology, Climatology and Physical Medicine 1996;59(3):141-147
9.Reduction of Glucocorticoids by Spa Therapy in Patients with Steroid-Dependent Intractable Asthma(SDIA).
Yasuhiro HOSAKI ; Takashi MIFUNE ; Fumihiro MITSUNOBU ; Satoshi YOKOTA ; Yoshiro TANIZAKI ; Koji OCHI ; Hideo HARADA ; Satoru IKEDA ; Kazuhisa TAKETA
The Journal of The Japanese Society of Balneology, Climatology and Physical Medicine 1996;59(4):201-208
10.Improvement of Forced Vital Capacity(FVC) by Spa Therapy in Patients with Bronchial Asthma.
Fumihiro MITSUNOBU ; Takashi MIFUNE ; Yasuhiro HOSAKI ; Satoshi YOKOTA ; Yoshiro TANIZAKI ; Koji OCHI ; Hideo HARADA ; Satoru IKEDA ; Kazuhisa TAKETA
The Journal of The Japanese Society of Balneology, Climatology and Physical Medicine 1996;59(4):218-224