Objective: The purpose of the present study is to clarify the efficacy of etidronate and vitamin K2 in sustaining bone mineral density (BMD) in patient with hip fracture by monitoring metabolic bone markers and BMD during the 36-week period after fracture.Materials and Methods: Forty-seven hip fracture patients from 51 to 93 years old (77.2±9.6) were randomly divided into three groups: 14 patients in the intermittent cyclical etidronate-treated group (group E), 16 patients in the vitamin K2-treated group (group K), and 17 patients in the control (group C). Drugs were administered to patients in groups E and K six weeks after their operations. Blood and urine samples were obtained just before the start of drug administration and at 12, 24, and 36 weeks thereafter. Urinary type I collagen C-terminal telopeptide (uCTx), pyridinoline (PYR), deoxypyridinoline (DPD), serum CTx (sCTx), osteocalcin (OCN-mid), and undercarboxylated osteocalcin (ucOC) were measured. The contra-lateral proximal femur and lumbar spine BMDs were measured at baseline and at 36 weeks.Results: Deoxypyridinoline at 12 weeks and OCN-mid at 36 weeks after treatment were lower in group E than those in group C. N-mid osteocalcin and ucOC at 24 and 36 weeks were lower in group K than those in group C. Although femoral neck BMD in groups C and E decreased compared to the baseline values at 36 weeks, femoral neck BMD in group K tended to increase. Specifically, in group K the BMD of Ward's triangle increased significantly after treatment. Bone mineral density of the lumbar spine in each group did not change significantly during the 42 weeks following hip fracture.Conclusion: Vitamin K2 prevented further bone loss in the contralateral proximal femur. The administration of vitamin K2 to patients with hip fractures in the early period after fracture is potentially useful in preventing a second hip fracture on the contralateral side.
week ; Carbon ion ; Upper Case Kay ; Hip Fractures ; Upper case ee

Background: Spring water exhibits “aging”, characterized by increased oxidation reduction potential (ORP) and diminished therapeutic efficacy. However, the influence of spring water ORP on the body during bathing is unknown. Gout has been treated by spa bathing and by acupuncture, as well as pharmacologically. We accordingly examined the relationship between ORP and uric acid excretion, and that between ORP and ryodoraku current, which is closely related to acupuncture.
Design: Three groups of three volunteers each bathed in a different solution; sulphur-containing spring water, bicarbonate-containing spring water, or tap water. Serial changes in uric acid excretion and ryodoraku were measured.
Results: Urinary uric acid: creatinine ratio and ryodoraku current increased after sulphur spring water bathing and diminished after tap water bathing. Urinary ORP was negatively correlated with urinary uric acid: creatinine ratio and urinary pH. Ryodoraku current and urine ORP changed in opposite directions.
Conclusion: Bathing water ORP affected urinary ORP, urinary uric acid excretion, and ryodoraku current. Urinary ORP was assumed to reflect interstitial fluid ORP, suggesting that uric acid excretion and ryodoraku current were affected by interstitial fluid ORP. These findings appeared to indicate that ORP influenced cell membrane potential because voltage-dependent transporters or channels exist in the kidney and epidermis. Moreover, as urinary ORP was negatively correlated with urinary pH, ORP seemed to electrically buffer pH. As these findings can be explained by the Nernst equation by which ORP is derived, ORP of spring water might electrically influence the organism during bathing.

Objective: The aim of the present study was to clarify whether patients with Graves' disease who have lost bone mass can restore bone mass to age-matched control levels by antithyroid drug therapy.Patient/Materials and Methods: One male and 16 female patients (aged 21-71 years, mean±SE 39.9±16.5) with untreated Graves' disease were included in the study. Methimazole or propylthiouracil was given to all of the patients. Biochemical markers (serum N-mid osteocalcin (OCN-mid), alkaline phosphatase (ALP), type I collagen C-terminal telopeptide (sCTx), urinary pyridinoline (Pyr), deoxypyridinoline (Dpyr) and type I collagen C-terminal telopeptide (uCTx) and bone mineral density at the distal one third of the radius were assessed prior to treatment, and in the first, third, sixth and twelfth months of treatment.Results: All biochemical markers had increased significantly 12 months after treatment compared with the baseline values (OCN-mid, p<0.05; ALP, p<0.01; sCTx, p<0.05; Pyr, Dpyr, uCTx, p<0.01). Among the biochemical markers, urinary Pyr and Dpyr had decreased the most prominently 12 months after treatment. However, BMD at the distal one third of the radius did not improve after 12 months of treatment.Conclusion: Based on assessments of BMD at the distal one third of the radius, one year is not enough to restore bone mass using antithyroid drug therapy in patients with Graves' disease.
therapeutic aspects ; month ; lower case pea ; Markers, Biochemical ; pharmacotherapeutic

Thirty-four patients with congenital cardiac disease were studied to evaluated the role of ultrafiltration after cardiopulmonary bypass without homologous blood transfusion. We used either polypropylene microporous hollow fiber hemoconcentrator (HC-30M or 100M) or polyacrylonitrile microporous hollow fiber hemoconcentrator (PHC-500). Ultrafiltration was useful in the reduction of fluid overloading after cardiopulmonary bypass with extreme hemodilution. Thirty-two patients tolerated the procedure uneventfully without donor blood transfusion and were discharged from the hospital. The values of hematocrit, serum protein and free hemoglobin increased significantly after ultrafiltration with either type of hemoconcentrator. However the degree of concentration of blood components was significantly higher with polyacrylonitrile hemoconcentrator than those with polypropylene hemoconcentrator. These results indicated that ultrafiltration was useful for maintaining water balance after cardiopulmonary bypass without homologous blood transfusion in pediatric cardiac surgery and that polyacrylonitrile microporous hollow fiber hemoconcentrator should be employed in patients with shorter bypass time and less hemolysis.

Transcatheter embolization of 25 aortopulmonary collateral arteries (7 bronchial arteries and 18 intercostal arteries) was attempted prior to intracardiac repair in 7 patients. The underlying disease was tetralogy of Fallot in 3 patients, pulmonary atresia with ventricular septal defect in 2, double-outlet right ventricle with ventricular septal defect and pulmonary stenosis in 1 and tricuspid stenosis with pulmonary atresia in 1. The intervals between embolization and intracardiac repair ranged from 0 to 17 days (mean 4.5 days). Embolization resulted in total occlusion in 7 bronchial arteries and 17 intercostal arteries, with an overall success rate of 96%. Complications included a coil dislodgement from a collateral artery into the aorta in one patient, necessitating surgical removal of the dislodged coil from the femoral artery, an exacerbation of cyanosis and dyspnea on exercise in 5, and slight fever in 2. In one patient with tetralogy of Fallot, who had 5 collateral vessels, transcatheter embolization caused hypoxemia, bradycardia and hypotension and therefore intracardiac repair was performed immediately after embolization. Aortopulmonary collateral arteries in patients with congenital heart disease can be effectively treated by transcatheter embolization. Embolization should be performed just before intracardiac repair because an excessive decrease in arterial oxygen saturation after embolization may require an emergency operation.

Objective: The purpose of the present study was to clarify the efficacy of alendronate and raloxifene for preventing bone loss in patients with hip fracture by monitoring bone mineral densities (BMDs) and biochemical markers during the 9-month period after fracture. Patients and Methods: Eighty-two female hip fracture patients from 50 to 99 years old (mean ± SD: 81.6 ± 9.5) were randomly divided into two groups; there were 46 patients in the alendronate-treated group (group ALN) and 36 patients in the raloxifene-treated group (group RLX). Drugs were administered to patients six weeks after their operations. Lumbar spine BMD and neck, trochanter, Ward's and total BMDs of the contralateral proximal femur, serum intact osteocalcin (intact OC), bone-specific alkaline phosphatase (BAP) and urinary N-terminal telopeptide of type I collagen (NTX) were measured just before the start of drug administration and at 9 months thereafter. Results: Twenty-two out of 46 patients in group ALN and 23 out of 36 patients in group RLX completed the study. The most common reason for dropping out was the patient's failure to visit the outpatient clinic. Trochanter BMD in group ALN tended to increase by 8.4% compared with the baseline, and total hip BMD in group RLX showed a significant increase (5.7%), although neck BMD in both groups decreased during the 9 months of treatment (–8.7% for group ALN and –4.2% for group RLX compared with the baseline). Spine BMD did not change significantly in eithr group. Serum BAP and urinary NTX decreased significantly in both groups. Serum intact OC did not change significantly. Conclusions: Both alendronate and raloxifene have a favorable effect on trochanter and total BMDs of the contralateral proximal femur in the short period after hip fracture. However, both drugs could not prevent bone loss in the femoral neck during the 9 months of treatment.

Purpose：This study examined functional outcomes and discharge disposition in patients with and without indwelling urethral catheters, who were admitted to a convalescent (Kaifukuki) rehabilitation ward (KRW) following an acute care hospital stay.Subjects and Methods：We retrospectively reviewed the medical records of 113 patients with cerebrovascular disease and traumatic brain injury who had indwelling urethral catheters at the time of admission to the KRW of our hospital between April 1, 2012 and March 31, 2015. We studied the motor score of the Functional Independence Measure (FIM-M) and discharge disposition from our KRW in patients without indwelling urethral catheters.Results：The ratio of patients without indwelling urethral catheters was 75.2％ (85 cases：catheter-free group). The catheter-free group had higher FIM-M scores and a higher rate of living at home, compared to the 28 patients with indwelling urethral catheters. The average duration until urination independence after catheter removal was 17.3 (standard deviation：21.1) days. Urination independence recovered in 80.9％ of the catheter-free group within 4 weeks after catheter removal.Conclusion：Indwelling urethral catheter should be removed to enable discharge to home.

BACKGROUND: Use of complementary and alternative medicine (CAM) has become popular in Japan.
OBJECTIVE: To investigate associations of symptom-related CAM use with sociodemographic factors in Japan.
DESIGN AND SETTING: A prospective cohort study of a nationally representative sample of households in Japan.
PARTICIPANTS: Community-dwelling adults who developed at least one symptom during a 31-day period.
MAIN OUTCOME MEASURES: Self-reported, symptom-related use of CAM, either physical CAM or oral CAM.
RESULTS: Of 2, 453 adults, 2, 103 participants (86%) developed at least one symptom. Of these symptomatic adults, 156 (7.4% ; 95% CI: 6.3-8.5%) used physical CAM therapy. The likelihood of using physical CAM was not significantly influenced by annual household income, employment, or education. Participants living in large cities had an increased likelihood of using physical CAM with an odds ratio (OR) of 2.6 (95% CI: 1.2-5.8), compared to those living in rural areas. Oral CAM therapy was used by 480 participants (22.8%; 95% CI: 21.0-24.6%) among the symptomatic adults. An age of 60 years old and older (OR 2.0; 95% CI: 1.2-3.3) and female gender (OR 1.8; 95% CI: 1.3-2.6) were significantly associated with an increased use of oral CAM. The unemployed participants had a lower likelihood of using oral CAM, with an OR of 0.6 (95% CI: 0.4-0.9), compared to the employed.
CONCLUSIONS: Oral CAM use is common among Japanese patients and is associated with older age, female gender, and employed status, while physical CAM use is less common and is associated with living in a large city.

The preoperative pulmonary arterial pressure of 38 patients aged over 50 undergoing surgical closure of a secundum atrial septal defect was studied. They were divided into three groups according to systolic pulmonary arterial pressure (PAP): Group A (PAP<30mmHg, n=14), Group B (30≤PAP<50mmHg, n=16), and Group C (PAP≥50mmHg, n=8). The mean age of group C patients was older than that of group A patients. With higher PAP, the Pp/Ps, Rp/Rs and cardiothoracic ratios increased, atrial fibrillation and heart failure (NYHA≥2) were more frequent, and PaO₂ levels declined. There were no differences in left to right shunt ratio and Qp/Qs among the three groups. The PAP and Rp/Rs were under 70mmHg and 0.30, respectively in all patients. High pulmonary blood flow seems to be the cause of pulmonary hypertension in most elderly patients because PAP and Rp/Rs decreased after surgery in all groups. Findings of cardiomegaly and heart failure also improved after surgery. Surgical intervention is recommended even in elderly patients with a ASD.

Pulmonary blastoma is rare and its prognosis very poor. A 6-year-old boy was referred to our hospital with chest pain. Computed tomography demonstrated that the left pleural cavity was filled with a tumor. Cardiac echocardiography demonstrated that the tumor had invaded through the pulmonary vein into the left atrium and that the tumor extended into the left ventricle. Part of the tumor was adhered to the anterior leaflet of the mitral valve. To increase operative radicality, an autotransplantation technique was performed concomitantly with resection of the original lesion. Through a median sternotomy, a moderate hypothermic cardiopulmonary bypass was established to obtain cardiac arrest. First, longitudinal incision of right-sided of the left atrium was made. The tumor invaded into the left atrium through the left superior pulmonary orifice. The ascending aorta, the main pulmonary artery, and both caval veins were transected. The left atrium was incised along the pulmonary venous orifices. The heart was completely removed from the mediastinum and transferred to another table. Resection of the intracardiac metastatic lesion and mitral valve replacement was accomplished. During this time, thoracic surgeons performed a left pneunectomy. The left atrial wall around the left pulmonary venous orifices was resected in combination with the left lung. After the deficit of the left atrial wall was repaired with a Gore-Tex patch, the heart was replaced and we reconstructed the great arteries and caval veins. The autotransplantation technique is a useful procedure for combined lesions of the heart and lung.