1.Spontaneous Renal Artery Dissection: An Important Differential Diagnosis for Sudden Onset of Back Pain
Koshi Ota ; Eugene Kua ; Masatoshi Imamura ; HengJie Xu ; Masaaki Okutsu ; Takashi Kitao ; Naoko Takaoka
General Medicine 2013;14(2):126-129
Spontaneous renal artery dissection (SRAD) is uncommon and hence diagnosis is often delayed when ideally a quick one is preferred. We report a case of a 53 year-old male, with a known history of nephrolithiasis, who was admitted into hospital complaining of sudden onset left-sided back pain. Ultrasound showed a right-sided calculus instead of the expected left. A subsequent contrast computed tomography (CT) scan was done showing an infarcted segment of the left kidney. Further investigation with angiography and intravascular ultrasound (IVUS) revealed the presence of two left renal arteries with the distal originating left renal artery having dissected.
2.A Case of Left Atrial Myxoma with Right Renal Infarction as an Initial Clinical Symptom.
Takahiko Aoyama ; Takashi Ota ; Chihiro Narumiya ; Takenori Mase ; Kensuke Shioi ; Yoshihisa Nagata
Japanese Journal of Cardiovascular Surgery 1999;28(6):381-384
We reported a case of left atrial myxoma with renal infarction as an initial clinical symptom. A 65-year-old man had severe right lumbago. A chest CT demonstrated right renal artery embolism. On emergency operation a right renal embolus was removed. Preoperative echocardiography and transesophageal echo showed a tumor in his left atrium which was close to the mitral valve. The tumor was resected one week after the first operation. Embolectomy of the right renal artery could not restore renal function. To the best of our knowledge, this type of cardiac myxoma with renal infarction as an initial clinical symptom is rare.
3.Strengthening the communicable disease surveillance and response system, Amhara Region, Ethiopia, 2012-2014: Review of a technical cooperation project
Masaki Ota ; Yumi Toyama ; Mami Kon ; Takashi Yoza ; Belay Bezabih Beyene
Journal of International Health 2017;32(1):1-8
Objectives
The International Health Regulations (2005) bound the member states of the World Health Organization (WHO) to initiate epidemiological investigations of disease outbreaks and to notify WHO within 24 hours of their detection if the event is deemed to constitute public health emergency of international concern. The Japan International Cooperation Agency started the Amhara Regional Infectious Disease Surveillance Project to strengthen the surveillance and response system in the Amhara Region of Ethiopia in 2008. The objectives of the study were to review the project activities and to share the experiences and lessons learned in 22 districts of the North and South Gondar and West Gojjam Zones from mid-2012 through 2014.
Methods
We conducted training for district surveillance officers and focal point personnel at health centres (HCs), monitoring visits to district health offices and HCs, held review meetings on surveillance, and provided technical assistance in outbreak investigations. We evaluated the project activities in terms of the timeliness of the surveillance reports submitted by the health facilities, provision of technical assistance in outbreak investigations, and the number of training sessions held for the surveillance personnel.
Results
The timeliness of submission of surveillance reports had improved to almost 100% at end of 2014 compared with before the review period (about 68%). From the third quarter of 2013, we conducted monitoring visits to 59 HCs every semester. We were involved in 11 outbreak investigations of measles, anthrax, pertussis, neonatal tetanus, and typhoid fever. We held a total of 25 training sessions for district surveillance officers and HC focal points.
Conclusion
The project successfully strengthened the surveillance and response system. We recommend that the Amhara Regional Health Bureau maintain its commitment to the system in terms of human resources and funding. Training for surveillance officers and focal points should be conducted periodically.
4.A Case of Functional Constipation and Abdominal Distension Treated with Kobokushokyohangeninjinkanzoto
Shohaku YAMAMOTO ; Shizuka OTA ; Masaki SONODA ; Atsuko TAKATA ; Rie KATORI ; Takashi ITO
Kampo Medicine 2017;68(2):111-116
Constipation is one of the most common symptoms seen in elderly people, and is sometimes difficult to treat. Daikenchuto is a well-known Kampo formulation for treating ileus. Here, we report a case in which daikenchuto was not effective and constipation was effectively treated with kobokushokyohangeninjinkanzoto. The patient was an 81-year-old woman who had been hospitalized for treatment of a thighbone fracture. She was originally constipated, and her constipation had worsened over the course of hospitalization. Colonoscopy examination and abdominal computerized tomography showed no structural lesions. Her constipation improved after the administration of daikenchuto, but the improvement was transient. Since the constipation and abdominal distension worsened after she began eating again, we administered kobokushokyohangeninjinkanzoto. Subsequently, her condition improved remarkably. Eight days later, we changed the initial kobokushokyohangeninjinkanzoto to ninjinto and hangekobokuto. Her complaint did not recur, and she was discharged 17 days later. In case of deficiency pattern ileus, kobokushokyohangeninjinkanzoto may be considered as an alternative to daikenchuto. Furthermore, we believe that the combination of ninjinto and hangekobokuto is an effective alternative to kobokushokyohangeninjinkanzoto.
5.Two Cases of Cardiac Failure in the Elderly Successfully Treated with Shimbuto
Shohaku YAMAMOTO ; Masaki SONODA ; Shizuka OTA ; Atsuko TAKATA ; Masataka SUGAO ; Takashi ITO
Kampo Medicine 2017;68(2):117-122
We describe two cases of cardiac failure in elderly patients successfully treated with shimbuto. Case 1 was that of an 84-year-old man with severe aortic stenosis and liver cancer. His cardiac failure led to repeated hospitalization. After taking shimbuto, his pleural effusion decreased and cardio thoracic ratio improved. Case 2 was that of an 84-year-old man who was hospitalized because of cardiac failure and aspiration pneumonia after undergoing an operation for lung cancer. After taking shimbuto, his urine volume increased and cardiac failure improved. No notable adverse events were observed in any of the abovementioned cases. It is important that kanzo is not included in shimbuto to demonstrate risui action, hence the use of other “ho” formulations should be avoided. These cases suggest that shimbuto is indicated for elderly patients with cardiac failure under terminal care.
6.The Effectiveness of Shimotsuto Extract for Patients with Muscle Cramp
Takashi ITO ; Yoko KIMURA ; Shizuka OTA ; Shohaku YAMAMOTO ; Norio SUDA ; Kazuhiro NAKAZAWA
Kampo Medicine 2015;66(3):244-249
The effectiveness of the Kampo medicine shakuyakukanzoto extract for patients with muscle cramp is well known, but recently side effects related to pseudoaldosteronism have also been reported. To avoid this issue, Kampo medicines without Glycyrrhizae Radix are needed for treatment of muscle cramp. We investigated the therapeutic effect of shimotsuto extract, which has traditionally been used to treat anemia, in 26 patients (mean age : 70.7 ± 12.1 years) with muscle cramp. Improvement of the symptom was noted in 18 patients (69%), with no change in 8 patients (31%). The abdominal muscle tension of the former patients was significantly lower than the latter. Here, the cases of four representative patients in whom muscle cramp was improved by shimotsuto are described. The response rate to shimotsuto was similar to that of shakuyakukanzoto. Our results suggest that shimotsuto extract is a suitable alternative to shakuyakukanzoto for treatment of muscle cramp in older non-robust type patients not in need of emergency care.
7.Endoscopic Ultrasound-Guided Gastroenterostomy for Afferent Loop Syndrome
Hideyuki SHIOMI ; Arata SAKAI ; Ryota NAKANO ; Shogo OTA ; Takashi KOBAYASHI ; Atsuhiro MASUDA ; Hiroko IIJIMA
Clinical Endoscopy 2021;54(6):810-817
Afferent loop syndrome (ALS) is a mechanical obstruction of the afferent limbs after gastrectomy with gastrojejunostomy reconstruction. Patients with cancer recurrence require immediate and less invasive treatment because of their poor condition. Percutaneous transhepatic/transluminal drainage (PTD) and endoscopic enteral stenting offer reasonable palliative treatment for malignant ALS but are not fully satisfactory in terms of patient quality of life (QoL) and stent patency. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using a lumen-apposing metal stent may address these shortcomings. Clinical data from 11 reports showed that all patients who had undergone EUS-GE had positive technical and clinical outcomes. The adverse event rate was 11.4%, including only mild or moderate abdominal pain, with no severe adverse events. Indirect comparative studies indicated that patients who had undergone EUS-GE had a significantly superior QoL, a higher clinical success rate, and a lower reintervention rate than those who had undergone PTD or endoscopic enteral stenting. Although the evidence is limited, EUS-GE may be considered as a first-line treatment for malignant ALS because it has better clinical outcomes than other less invasive treatments, such as PTD or endoscopic enteral stenting. Further prospective randomized control trials are necessary to establish EUS-GE as a standard treatment for ALS.
8.Calcitonin induces connective tissue growth factor through ERK1/2 signaling in renal tubular cells.
Misa NAKAMURA ; Takashi OZAKI ; Aiko ISHII ; Masayoshi KONISHI ; Yuji TSUBOTA ; Toru FURUI ; Hayato TSUDA ; Ichiro MORI ; Kiichiro OTA ; Kennichi KAKUDO
Experimental & Molecular Medicine 2009;41(5):307-314
Calcitonin (CT), a polypeptide hormone, plays important roles in a variety of physiological processes. CT has been used clinically to treat osteoporosis and humoral hypercalcemia of malignancy. In order to clarify the pharmacological effects of CT in the kidney, we identified potential downstream genes induced by CT in the renal cells. Using a cDNA subtraction hybridization method, we identified connective tissue growth factor (CTGF) as a CT-induced gene in the porcine renal cell line, LLC-PK1. Furthermore, we found that CT-mediated induction of the gene was not inhibited by cycloheximide, which suggests that CTGF gene was not induced by an increased synthesis of regulating proteins. Therefore, CTGF is an immediate early gene. We further demonstrated that the regulation of CTGF gene expression by CT involved the ERK1/2 pathway, because PD98059, a MEK1 inhibitor, partially inhibited the mRNA expression of CTGF induced by CT. CT-induced CTGF protein expression was also observed in vivo. Our present findings suggest that CT induces the transcription of CTGF through ERK1/2 phosphorylation. We also identified twelve other genes induced by CT that, like CTGF, were related to wound healing. These results suggest that CT may have an effect on renal differentiation and wound healing in the kidney.
Animals
;
Calcitonin/*pharmacology
;
Cell Line
;
Connective Tissue Growth Factor/*genetics/metabolism
;
Female
;
Kidney Tubules, Proximal/*enzymology/metabolism
;
*MAP Kinase Signaling System
;
Mice
;
Mice, Inbred BALB C
;
Mitogen-Activated Protein Kinase 1/*metabolism
;
Mitogen-Activated Protein Kinase 3/*metabolism
;
Phosphorylation
;
Swine
9.Calcitonin induces connective tissue growth factor through ERK1/2 signaling in renal tubular cells.
Misa NAKAMURA ; Takashi OZAKI ; Aiko ISHII ; Masayoshi KONISHI ; Yuji TSUBOTA ; Toru FURUI ; Hayato TSUDA ; Ichiro MORI ; Kiichiro OTA ; Kennichi KAKUDO
Experimental & Molecular Medicine 2009;41(5):307-314
Calcitonin (CT), a polypeptide hormone, plays important roles in a variety of physiological processes. CT has been used clinically to treat osteoporosis and humoral hypercalcemia of malignancy. In order to clarify the pharmacological effects of CT in the kidney, we identified potential downstream genes induced by CT in the renal cells. Using a cDNA subtraction hybridization method, we identified connective tissue growth factor (CTGF) as a CT-induced gene in the porcine renal cell line, LLC-PK1. Furthermore, we found that CT-mediated induction of the gene was not inhibited by cycloheximide, which suggests that CTGF gene was not induced by an increased synthesis of regulating proteins. Therefore, CTGF is an immediate early gene. We further demonstrated that the regulation of CTGF gene expression by CT involved the ERK1/2 pathway, because PD98059, a MEK1 inhibitor, partially inhibited the mRNA expression of CTGF induced by CT. CT-induced CTGF protein expression was also observed in vivo. Our present findings suggest that CT induces the transcription of CTGF through ERK1/2 phosphorylation. We also identified twelve other genes induced by CT that, like CTGF, were related to wound healing. These results suggest that CT may have an effect on renal differentiation and wound healing in the kidney.
Animals
;
Calcitonin/*pharmacology
;
Cell Line
;
Connective Tissue Growth Factor/*genetics/metabolism
;
Female
;
Kidney Tubules, Proximal/*enzymology/metabolism
;
*MAP Kinase Signaling System
;
Mice
;
Mice, Inbred BALB C
;
Mitogen-Activated Protein Kinase 1/*metabolism
;
Mitogen-Activated Protein Kinase 3/*metabolism
;
Phosphorylation
;
Swine
10.Prognostic Factors after Surgical Treatment for Spinal Metastases
Kazuhiro MUROTANI ; Shunsuke FUJIBAYASHI ; Bungo OTSUKI ; Takayoshi SHIMIZU ; Takashi SONO ; Eijiro ONISHI ; Hiroaki KIMURA ; Yasuyuki TAMAKI ; Naoya TSUBOUCHI ; Masato OTA ; Ryosuke TSUTSUMI ; Tatsuya ISHIBE ; Shuichi MATSUDA
Asian Spine Journal 2024;18(3):390-397
Methods:
A retrospective multicenter study was conducted. The study participants included 345 patients who underwent surgery for spinal metastases from 2010 to 2020 at nine referral spine centers in Japan. Data for each patient were extracted from medical records. To identify the factors predicting survival prognosis after surgery, univariate analyses were performed using a Cox proportional hazards model.
Results:
The mean age was 65.9 years. Common primary tumors were lung (n=72), prostate (n=61), and breast (n=39), and 67.8% (n=234) presented with osteolytic lesions. The epidural spinal cord compression scale score 2 or 3 was recognized in 79.0% (n=271). Frankel grade A paralysis accounted for 1.4% (n=5), and 73.3% (n=253) were categorized as intermediate or high risk according to the new Katagiri score. The overall survival rates were -71.0% at 6 months, 57.4% at 12, and 43.3% at 24. In the univariate analysis, Frankel grade A (hazard ratio [HR], 3.59; 95% confidence interval [CI], 1.23–10.50; p<0.05), intermediate risk (HR, 3.34; 95% CI, 2.10–5.32; p<0.01), and high risk (HR, 7.77; 95% CI, 4.72–12.8; p<0.01) in the new Katagiri score were significantly associated with poor survival. On the contrary, postoperative chemotherapy (HR, 0.23; 95% CI, 0.15–0.36; p<0.01), radiation therapy (HR, 0.43; 95% CI, 0.26–0.70; p<0.01), and both adjuvant therapy (HR, 0.21; 95% CI, 0.14–0.32; p<0.01) were suggested to improve survival.
Conclusions
Surgical indications for patients with Frankel grade A or intermediate or high risk in the new Katagiri score should be carefully considered because of poor survival. Chemotherapy or radiation therapy should be considered after surgery for better survival.