1.The Effect of Bilateral Total Knee Arthroplasty (TKA) in a Stroke Patient with Hemiplegia and Knee Osteoarthritis
Takeshi YAMAGUCHI ; Satoru MATAYOSHI ; Yukiaki KISHIMOTO ; Naoto HAMASAKI ; Akira OMINE
The Japanese Journal of Rehabilitation Medicine 2009;46(9):577-582
This is a case report evaluating the improvement of activities of daily living (ADL) after TKA in stroke patient with hemiplegia and knee osteoarthritis. The case was a 73-year-old female with left hemiplegia caused by cerebral infarction. She also suffered from severe bilateral knee osteoarthritis and obesity. The hemiplegia and knee dysfunction disturbed her ADL. When she was admitted to our hospital, her FIM motor subscore was 23 and body mass index (BMI) was 36.0. She went on a diet and continued rehabilitation. Her knees were treated conservatively. Six months after the stroke, her FIM motor subscore was 35 and BMI was 29.8. For the purpose of pain relief and improvement of range of motion, right TKA was performed seven months after stroke. And left TKA and lengthening of the gastrocnemius were performed eleven months after her stroke. Rehabilitation was continued carefully in order to avoid deep venous thrombosis. In addition, a left obturator nerve block was performed as treatment for spasticity of her hip adductor muscle. Fifteen months after the stroke, her FIM motor subscore was 77 and BMI was 25.7. TKA is a common treatment for osteoarthritis but when a patient has a stroke, it is difficult to determine whether to perform surgery or not. In this case, bilateral TKA achieved improvement of ADL. We suggest that even if a patient has stroke hemiplegia, TKA should be considered for knee osteoarthritis based on the appropriate assessment and careful risk management.
2.Post-traumatic Stress Disorder Symptoms in a Female Patient Following Repeated Teasing: Treatment with Gabapentin and Lamotrigine and the Possible Role of Sensitization.
Akira KISHIMOTO ; Yurie GOTO ; Kenji HASHIMOTO
Clinical Psychopharmacology and Neuroscience 2014;12(3):240-242
Post-traumatic stress disorder (PTSD) is a pathological response to trauma characterized by frequent recollections, recurrent nightmares, and flashbacks of the traumatic event(s). To date, the precise mechanisms underlying the development of PTSD remain unknown. Several studies have suggested that antiepileptic drugs, such as gabapentin and lamotrigine, may be effective in the treatment of PTSD symptoms. We report on a 15-year-old Japanese female junior high school student who developed PTSD symptoms following repeated teasing from male classmates. Additionally, we underscore the beneficial effects of treatment with gabapentin and lamotrigine on flashbacks and nightmares. This patient developed PTSD symptoms after repeated teasing from male classmates at school. Her flashbacks and nightmares were treated with a combination of gabapentin and lamotrigine. After recovery, treatment with lamotrigine alone controlled her symptoms. Our observations suggest that a process of sensitization may be involved in the development of PTSD symptoms. Additionally, gabapentin and/or lamotrigine were effective in the treatment of flashbacks and nightmares in this patient. Thus, doctors should consider using these anti-epileptic drugs as an alternative approach to treating PTSD symptoms.
Adolescent
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Anticonvulsants
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Asian Continental Ancestry Group
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Dreams
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Female
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Humans
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Male
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Stress Disorders, Post-Traumatic*
5.Possible Involvement of p38 MAP Kinase in Retinoid-stimulated Expression of Indian Hedgehog in Prehypertrophic Chondrocytes
Tsuyoshi Shimo ; Eiki Koyama ; Soichiro Ibaragi ; Naito Kurio ; Daisuke Yamamoto ; Tatsuo Okui ; Koji Kishimoto ; Hiroshi Mese ; Akira Sasaki
Oral Science International 2008;5(1):1-14
The mandibular condyle formation during temporomandibular joint (TMJ) development exhibits endochondral bone formation, and the elongation process is dependent on the normal cartilage proliferation and differentiation. Retinoids are important for maturation of growth-plate chondrocytes, but the identity of their downstream effectors remains unclear. In this study, we carried out a series of studies at the cellular, biochemical, and molecular levels to determine whether, and if so how, retinoid signaling is related to the expression and function of Indian hedgehog (Ihh) in chondrocyte proliferation. First we analyzed the RA receptor (RAR) and Ihh expression pattern in E18 mandibular condyle. RARα and RARβ mRNA were characterized in the perichondrium around the condyle, whereas RARγ mRNA was expressed in the immature and prehypertrophic chondrocytes and the expression was overlapped with Ihh gene expression. Next we established a high-density culture model of chick cephalic chondrocytes in the prehypertrophic stage. We found that all-trans retinoic acid (RA) induced Ihh mRNA gene expression in this system. The RA pan-antagonist Ro 41-5253 inhibited both endogenous and RA-induced Ihh mRNA in a dose-dependent manner. The Ihh mRNA expression induced by RA required de novo protein synthesis, and was mediated by RARγ. Immunoblots showed that the prehypertrophic chondrocytes contained sizable levels of phosphorylated p38 mitogen-activated protein (MAP) kinase that were time- and dose-dependently increased by the RA treatment. Experimental p38 inhibition led to a severe drop in baseline and RA-stimulated Ihh expression. Exogenous recombinant Ihh stimulated the proliferation of proliferating chondrocytes, whereas RA inhibited the proliferation of these chondrocytes through p38 MAPK. Retinoids appear to play a primary role in controlling both the expression and function of Ihh in prehypertrophic chondrocytes and do so via p38 MAP kinase.
6.Gallbladder Dysfunction Diagnosed by Cholescintigraphy with a Fatty Meal.
Akira HOKAMA ; Kazuto KISHIMOTO ; Yasushi IHAMA ; Hiroshi CHINEN ; Fukunori KINJO ; Jiro FUJITA
Gut and Liver 2010;4(4):556-557
No abstract available.
Gallbladder
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Meals
7.Permeabilities of rebamipide via different intestinal mucosa in the diffusion chamber in vitro.
Guo-Feng LI ; Chun-Xia WANG ; Yuan YAN ; Nobuaki KISHIMOTO ; Akira YAMAMOTO
Acta Pharmaceutica Sinica 2008;43(3):314-317
The objective of this study is to investigate the permeabilities of rebamipide across the jejunal, ileal and colonic membranes in rat. The permeability (Papp) of rebamipide via rat intestinal membranes at concentration of 80 micromol L(-1) was evaluated by an in vitro diffusion chamber system after the membranes were isolated from the rat intestine. And the concentration of rebamipide in the receptor was determined by HPLC. As a result, the permeability of rebamipide across the jejunal or ileal membrane was higher than that across the colonic membrane, and the permeability of rebamipide in the ileal tissue from the serosal to mucosal direction was greater than that from the mucosal to serosal direction. Therefore, there was a regional difference in the permeability of rabamipide across the jejunum, ileum and the colon in rat. Also, the transporters in the intestinal mucosa as p-glycoprotein may not be involved in the transport of rebamipide.
Alanine
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analogs & derivatives
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pharmacokinetics
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Animals
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Antioxidants
;
pharmacokinetics
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Biological Transport
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Cell Membrane Permeability
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Colon
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metabolism
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Female
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Humans
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Ileum
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metabolism
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Intestinal Absorption
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Intestinal Mucosa
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metabolism
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Intestines
;
cytology
;
metabolism
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Jejunum
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metabolism
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Male
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Permeability
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Quinolones
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pharmacokinetics
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Rats
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Rats, Wistar
8.1.How Can We Promote Work Style Reforms of Cardiovascular Surgeons ?
Hiromi WADA ; Hiroki ARASE ; Yoshinori INOUE ; Koki ETO ; Yuichiro KISHIMOTO ; Yusuke KINUGASA ; Hiroshi KURAZUMI ; Hiroshi KODAMA ; Sayako NAKAGAWA ; Taisuke NAKAYAMA ; Kenji NAMIGUCHI ; Akira FUJITA ; Hiromu HORIE
Japanese Journal of Cardiovascular Surgery 2020;49(1):1-U1-1-U4
The work style of doctors gets attention within the Work Style Reforms that have been fully implemented since 2019. Now, we conducted a questionnaire survey at 10 institutions in Chugoku and Shikoku region and reviewed the latest work style of cardiovascular surgeons in comparison with other departments.
9.Current Status and Influencing Factors of the Stockpiling of Regular Medicines for Disasters in Patients with Chronic Disease
Akira MITOYA ; Ryota KUMAKI ; Ryoo TANIGUCHI ; Mitsuhiro SOMEYA ; Ryuichi KINOSHITA ; Tomoyuki SUZUKI ; Seiichi FURUTA ; Keiko AKAGAWA ; Keiko KISHIMOTO
Japanese Journal of Social Pharmacy 2024;43(1):2-11
To promote the stockpiling of regular medicines for disasters (SMD), we investigated SMD rates and clarified the relationship between SMD status (Yes or No) and the characteristics of patients with chronic diseases. A survey was provided to patients visiting the pharmacies in Hokkaido. SMD was defined as a patient having a supply of regular medicine for 7 days or more and replacing with new medicine within one year. Of a total of 537 participants (51.0% male; mean age 65.8 years), 61.1% had experienced a major disaster. The SMD rate was extremely low at 15.3%. The median score for a patient’s understanding of the regular medicine names (5-point scale: 1＝hardly understood, 5＝almost understood) was 2. The median number of monthly pharmacy visits was 0.8. 5.4% were recommended SMD by physicians or pharmacists. Results from multiple logistic regression analysis indicated that positive patient characteristics included age (OR＝1.154, 95%CI [1.026-1.298], P＝0.017), understanding of the regular medicine names (1.724, [1.039-2.859], P＝0.035), and recommendation of SMD by physicians or pharmacists (5.991, [2.616-13.722], P<0.001). A negative patient characteristic was the number of pharmacy visits (0.587, [0.383-0.899], P＝0.014). The most influential positive factor was the recommendation of SMD by physicians or pharmacists; however, only 5.4% of the participants had experienced this. The findings of this study indicated important that health care providers and the government to work together to devise easy-to-understand measures to inform local residents about the importance of SMD and how to them, conduct educational activities.
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