2.COMPARISON OF THE GAIT OF WOMEN WITH A LOAD ON THEIR BELLY AND THAT OF PREGNANT WOMEN
HIROKI AOYAMA ; YOSUKE YAMADA ; MASAHIRO SHINYA ; HIDEAKI KUSUMOTO ; SHINGO ODA
Japanese Journal of Physical Fitness and Sports Medicine 2010;59(4):375-388
Gait analysis was conducted on 7 healthy pregnant women (pregnant group) and 6 non-pregnant women (pseudo-pregnant group) using a 3-D motion analysis system (VICON 460) and two forceplates (Kistlar 9286A). The data was collected at 8-9 months of gestation (pregnant condition) and 4-8 months postpartum (non-pregnant condition) in the pregnant group. In the pseudo-pregnant group, the participants walked with a 5kg-load on their belly (pregnant condition) and without any load (non-pregnant condition). Comparisons using two-way ANOVAs with repeated measures were conducted. Interaction of group × condition was not observed in the measured gait parameters except the angle of the maximum hip adduction. Main effect in the condition and the group was found in some parameters. In the pregnant condition, gait velocity was slower (pregnant group 68.7±8.6 m/min pseudo-pregnant group 63.8±4.8 m/min) than in the non-pregnant condition (pregnant group 75.5±3.2 m/min pseudo-pregnant group 69.8±8.7 m/min). The second vertical peak ground reaction force was smaller in the pregnant condition (pregnant group 105.4±4.8 % pseudo-pregnant group 108.4±6.3 % of body-weight) than in the non-pregnant condition (pregnant group 114.3±7.4 % pseudo-pregnant group 113.5±4.2 % of body-weight). These results demonstrated that pregnant condition changed kinetic and kinematic characteristics of the gait.
3.Feasibility of metronomic chemotherapy with tegafur-uracil, cisplatin, and dexamethasone for docetaxel-refractory prostate cancer
Hiroki Kubota ; Katsuhiro Fukuta ; Kenji Yamada ; Masahito Hirose ; Hiromichi Naruyama ; Yoshimasa Yanai ; Yasuyuki Yamada ; Hideki Watase ; Noriyasu Kawai ; Keiichi Tozawa ; Takahiro Yasui
Journal of Rural Medicine 2017;12(2):112-119
Objectives: To evaluate the efficacy of tegafur–uracil (UFT), a prodrug of 5-fluorouracil, plus cisplatin and dexamethasone in patients with docetaxel-refractory prostate cancers.
Methods: Twenty-five patients with docetaxel-refractory prostate cancer were administered oral UFT plus intravenous cisplatin (UFT-P therapy) and dexamethasone. Treatment responses were assessed monthly via prostate-specific antigen (PSA) level measurements. Treatment-related adverse events and overall survival were also assessed.
Results: UFT-P therapy resulted in decreased PSA levels in 14 (56%) patients and increased PSA levels in 11 (44%). In patients with increased PSA levels, 7 (64%) of the 11 patients displayed decreased PSA doubling times. The UFT-P therapy response rate was 84% (21/25 patients). Imaging studies revealed that tumor shrinkage during UFT-P therapy occurred in 1 patient in whom bilateral hydronephrosis caused by lymph node metastasis improved. The median survival time from docetaxel initiation was 36 months. In UFT-P-treated patients, the median PSA progression and overall survival times were 6 and 14 months, respectively. UFT-P treatment-related adverse events were mild diarrhea, general fatigue, and anorexia. Treatment was not discontinued for any of the patients. UFT-P therapy did not cause serious hepatic or renal dysfunction or pancytopenia.
Conclusions: UFT-P therapy is a safe and effective treatment for patients with docetaxel-refractory prostate cancer, although large-scale, multicenter, prospective studies are needed to validate these findings.
5.Cerebral air embolism associated with lung cancer invading the pulmonary vein, left atrium, and main bronchus
Hiroki Kuroda ; Masaru Yamada ; Toshihiro Kumabe
Neurology Asia 2020;25(2):221-223
Cerebral air embolism caused by lung cancer is extremely rare, especially if not associated with invasive
procedures such as needle biopsy. We describe the case of an 86-year-old man with squamous cell
lung carcinoma of the left lung. He developed a bad cough and subsequently suffered left hemiplegia.
Brain computed tomography (CT) on admission showed no abnormal findings. Diffusion-weighted
magnetic resonance (MR) imaging revealed high intensity lesions in the right frontal lobe and right
parietal lobes. Repeated brain CT revealed air densities around the high intensity lesions on previous
MR imaging, compatible with air embolism causing cerebral infarction. Chest CT confirmed a left
pulmonary hilar mass invading the left pulmonary vein, left atrium, and main bronchus. Air densities
were found in the left heart ventricle. These radiological findings were attributed to cerebral air embolism associated with advanced lung cancer. Shortly afterwards he died of progressive respiratory failure. Our case reveals two important aspects. First, cerebral air embolism can be caused by lung cancer invading the pulmonary vein, left atrium, and main bronchus without iatrogenic causes. Therefore, we should pay special attention to the etiology when the patients with lung cancer in the advanced stage developed cerebral infarction. Second, repeated CT is recommended if cerebral air embolism is suspected because initial head CT does not always reveal air bubbles.
6.Selective Angiography to Detect Anterior Spinal Artery Stenosis in Thoracic Ossification of the Posterior Longitudinal Ligament
Go YOSHIDA ; Hiroki USHIROZAKO ; Tomohiko HASEGAWA ; Yu YAMATO ; Tatsuya YASUDA ; Tomohiro BANNO ; Hideyuki ARIMA ; Shin OE ; Yuki MIHARA ; Tomohiro YAMADA ; Koichiro IDE ; Yuh WATANABE ; Takasuke USHIO ; Yukihiro MATSUYAMA
Asian Spine Journal 2022;16(3):334-342
Methods:
This study prospectively examined nine T-OPLL patients who underwent posterior thoracic decompression with kyphosis correction and instrumented fusion at Hamamatsu University School of Medicine between 2017 and 2019. All underwent preoperative selective angiography to detect and evaluate the Adamkiewicz artery and ASA. Intraoperative neuromonitoring and Doppler ultrasonography were performed to analyze neurological complications and spinal cord blood flow.
Results:
All nine patients showed ASA stenosis in the area of T-OPLL. In all patients, the Adamkiewicz artery was located between T7 and L2 and the area of ASA stenosis corresponded to the level of T-OPLL and greatest spinal cord compression; intraoperative Doppler ultrasonography confirmed the ASA defect at the same spinal level. The number of spinal levels from the Adamkiewicz artery to the most compressive OPLL lesion was greater in the two patients who developed postoperative neurological deficit compared to those who did not (5.5 vs. 2.3, p=0.014).
Conclusions
This is the first study to report detection of ASA stenosis in patients with T-OPLL. Maintaining spinal cord blood flow is important in these patients to avoid neurological deterioration.
7.Revision Surgery for a Rod Fracture with Multirod Constructs Using a Posterior-Only Approach Following Surgery for Adult Spinal Deformity
Yu YAMATO ; Tomohiko HASEGAWA ; Go YOSHIDA ; Tomohiro BANNO ; Shin OE ; Hideyuki ARIMA ; Yuki MIHARA ; Hiroki USHIROZAKO ; Tomohiro YAMADA ; Yuh WATANABE ; Koichiro IDE ; Keiichi NAKAI ; Kenta KUROSU ; Yukihiro MATSUYAMA
Asian Spine Journal 2022;16(5):740-748
Methods:
We retrospectively reviewed the medical records of 404 patients who underwent corrective fusion surgery for ASD with a minimum 2-year follow-up. We studied cases of reoperation for postoperative rod fractures and investigated surgical procedure, intraoperative findings, clinical course, and rod refracture following revision surgery.
Results:
Rod fracture was observed in 88 patients (21.8%). Fifty-three patients (average age, 68.3 years; average blood loss, 502.2 mL [% estimated blood volume=16.4%]; and operation time, 203.3 minutes) who suffered from a rod fracture at an average of 28.3 months after the primary operation underwent reoperation. Surgical invasiveness had no significant differences in total or partial rod replacement; however, the procedures with and without an anterior bone graft significantly differed. The replaced rod refractured at an average of 35.3 months after the revision surgery of five patients. The rod also refractured at a level outside multiple rods in two patients and with traumatic episodes in three patients. Three patients had bone grafts in the anterior column.
Conclusions
Revision surgery involving a multirod with a posterior-only approach for a rod fracture that occurred after ASD was performed successfully. Bone grafting in the anterior column is unnecessary for patients without massive bone defects.
8.Impact of Spinal Correction Surgeries with Osteotomy and Pelvic Fixation in Patients with Kyphosis Due to Osteoporotic Vertebral Fractures
Tomohiko HASEGAWA ; Hiroki USHIROZAKO ; Yu YAMATO ; Go YOSHIDA ; Tatsuya YASUDA ; Tomohiro BANNO ; Hideyuki ARIMA ; Shin OE ; Tomohiro YAMADA ; Koichiro IDE ; Yuh WATANABE ; Yukihiro MATSUYAMA
Asian Spine Journal 2021;15(4):523-532
Combination of retrospective and prospective study. We aimed to compare the clinical outcomes between local fixation surgery and spinopelvic fixation surgery for the treatment of kyphosis secondary to osteoporotic vertebral fractures with spinopelvic malalignment. The clinical characteristics of patients with rigid kyphosis due to osteoporotic vertebral fracture differ from that of middle-aged patients with vertebral fractures in terms of bone fragility and presence of spinopelvic malalignment. Little is known about the surgical strategies for these deformities, most especially the extent of fusion of vertebra involved. We analyzed 24 patients with vertebral osteotomy at the level of the fracture and spinal fixation without pelvic fixation (local group), and 22 patients with vertebral osteotomy and pelvic fixation (pelvic group). Radiographic parameters, the incidence of proximal junctional kyphosis (PJK), distal junctional kyphosis (DJK), rod fractures, and the Oswestry Disability Index (ODI) were compared between the two groups over a 2-year follow-up period. In the pelvic group, postoperative spinopelvic parameters significantly improved, with the improvements maintained. No remarkable changes in spinopelvic parameters were seen in the local group. The mean ODI scores 2 years after surgery were 45.3 and 33.0 in the local and pelvic group, respectively ( For patients with rigid kyphosis due to osteoporotic vertebral fractures, better spinopelvic alignment and health-related quality of life can be achieved through extensive corrective surgery with pelvic fixation.
9.Outcomes of Endoscopic Ultrasound-Guided Biliary Drainage in Patients Undergoing Antithrombotic Therapy
Nozomi OKUNO ; Kazuo HARA ; Nobumasa MIZUNO ; Shin HABA ; Takamichi KUWAHARA ; Hiroki KODA ; Masahiro TAJIKA ; Tsutomu TANAKA ; Sachiyo ONISHI ; Keisaku YAMADA ; Akira MIYANO ; Daiki FUMIHARA ; Moaz ELSHAIR
Clinical Endoscopy 2021;54(4):596-602
Background/Aims:
The Japan Gastroenterological Endoscopy Society (JGES) has published guidelines for gastroenterological endoscopy in patients undergoing antithrombotic treatment. These guidelines classify endoscopic ultrasound-guided biliary drainage (EUS-BD) as a high-risk procedure. Nevertheless, the bleeding risk of EUS-BD in patients undergoing antithrombotic therapy is uncertain. Therefore, this study aimed to assess the bleeding risk in patients undergoing antithrombotic therapy.
Methods:
This single-center retrospective study included 220 consecutive patients who underwent EUS-BD between January 2013 and December 2018. We managed the withdrawal and continuation of antithrombotic agents according to the JGES guidelines. We compared the bleeding event rates among patients who received and those who did not receive antithrombotic agents.
Results:
A total of 18 patients (8.1%) received antithrombotic agents and 202 patients (91.8%) did not. Three patients experienced bleeding events, with an overall bleeding event rate of 1.3% (3/220): one patient was in the antithrombotic group (5.5%) and two patients were in the non-antithrombotic group (0.9%) (p=0.10). All cases were moderate. The sole thromboembolic event (0.4%) was a cerebral infarction in a patient in the non-antithrombotic group.
Conclusions
The rate of EUS-BD-related bleeding events was low. Even in patients receiving antithrombotic therapy, the bleeding event rates were not significantly different from those in patients not receiving antithrombotic therapy.
10.Efficacy of Hypertonic Saline-Epinephrine Local Injection Around the Anal Side before Endoscopic Papillectomy for Ampullary Tumors
Naoki OKANO ; Yoshinori IGARASHI ; Ken ITO ; Saori MIZUTANI ; Hiroki NAKAGAWA ; Kouji WATANABE ; Yuuto YAMADA ; Kensuke YOSHIMOTO ; Yuusuke KIMURA ; Susumu IWASAKI ; Kensuke TAKUMA ; Seiichi HARA ; Yuui KISHIMOTO
Clinical Endoscopy 2021;54(5):706-712
Background/Aims:
Bleeding is a complication of endoscopic snare papillectomy for ampullary tumors. This study aimed to investigate the clinical efficacy of hypertonic saline-epinephrine (HSE) local injection before endoscopic papillectomy for prevention of bleeding.
Methods:
We retrospectively reviewed the data of 107 consecutive patients with ampullary tumors who underwent endoscopic papillectomy. The rates of en bloc resection, pathological resection margins, and prevention of immediate or delayed bleeding in the simple snaring resection group (Group A) and the HSE injection group (Group B) were compared.
Results:
A total of 44 and 63 patients were enrolled in Groups A and B, respectively. The total complete resection rate was 89.7% (96/107); the clinical complete resection rates in Group A and Group B were 86.3% (38/44) and 92.1% (58/63), respectively (p=0.354). Post-papillectomy bleeding occurred in 22 patients. In Groups A and B, the immediate bleeding rates were 20.5% (9/44) and 4.8% (3/63), respectively (p=0.0255), while the delayed bleeding rates were 7% (3/44) and 11% (7/63), respectively (p=0.52). The rates of positive horizontal and vertical pathological margin in both groups were 27% and 16%, respectively.
Conclusions
HSE local injection was effective in preventing immediate bleeding and was useful for safely performing endoscopic papillectomy for ampullary tumors.