1.The Role of On-Call Duty at the Tenri Hospital Emergency Department in Clinical Training in a General Outpatient Setting.
Hirotaka ONISHI ; Hiroyasu ISHIMARU ; Masatoshi MATSUMOTO ; Nobuaki INOUE ; Tetsuya YAMADA ; Noriyo YAMASHIKI ; Kentaro OKAZAKI ; Hiroshi NAKAI ; Kazuhiro HATTA ; Takanobu IMANAKA ; Shunzo KOIZUMI
Medical Education 1999;30(6):413-418
Objective: To investigate the role of postgraduate clinical training at the emergency department of Tenri Hospital in teaching the diagnostic process in the general outpatient department.
Method: Patients seen by 11 first-year residents at the emergency department were consecutively registered with summary sheets. Further information was added, and an analysis was performed of: 1) the distribution of chief complaints in the emergency and general outpatient departments and 2) initial diagnoses and the diagnostic process in the emergency department and the final diagnoses.
Results: The distributions of chief complaints in 89 cases in the emergency department and in 183 cases in the general outpatient department were closely correlated (p=0.0016). Diagnoses in the emergency department were correct in 58% of cases. Treatment was incorrect in 3% of cases.
Conclusion: The distributions of chief complaints in the emergency and general outpatient departments were similar. In our hospital the emergency department plays a major role in postgraduate clinical training by teaching the diagnostic process for the general outpatient department. Clinical management, including decision making for further tests and consultation, in the emergency department by first year residents did lead to any major adverse events.
2.Can Conventional Magnetic Resonance Imaging Substitute Three-Dimensional Magnetic Resonance Imaging in the Diagnosis of Lumbar Foraminal Stenosis?
Maruf Mohammad HASIB ; Kentaro YAMADA ; Masatoshi HOSHINO ; Eiji YAMADA ; Koji TAMAI ; Shinji TAKAHASHI ; Akinobu SUZUKI ; Hiromitsu TOYODA ; Hidetomi TERAI ; Hiroaki NAKAMURA
Asian Spine Journal 2021;15(4):472-480
Methods:
We investigated 154 foramina at L5–S1 in 77 patients. All the patients had degenerative lumbar disorders and had undergone both conventional MRI and 3D-MRI during the same visit. Differences between the FSRs calculated from conventional and 3D-MRI reconstructions and any correlations with the plain radiography findings were assessed.
Results:
In foramina that had a FSR of <50% on conventional MRI, the difference between the FSR obtained using conventional MRI and 3D-MRI was 5.1%, with a correlation coefficient of 0.777. For foramina with a FSR ≥50% on conventional MRI, the difference was 20.2%, with a correlation coefficient of 0.54. FSR obtained using 3D-MRI was significantly greater in patients who required surgery than in those who were successfully treated with conservative methods (88% and 42%, respectively). Segments with spondylolisthesis or lateral wedging showed higher FSRs than those without these conditions on both types of MRI.
Conclusions
FSRs <50% obtained using conventional MRI were sufficiently reliable; however, the results were inaccurate for FSRs ≥50%. Patients with high FSRs on 3D-MRI were more likely to require surgical treatment. Therefore, 3D-MRI is recommended in patients with suspected stenosis detected using conventional MRI or plain radiographs.
3.Can Conventional Magnetic Resonance Imaging Substitute Three-Dimensional Magnetic Resonance Imaging in the Diagnosis of Lumbar Foraminal Stenosis?
Maruf Mohammad HASIB ; Kentaro YAMADA ; Masatoshi HOSHINO ; Eiji YAMADA ; Koji TAMAI ; Shinji TAKAHASHI ; Akinobu SUZUKI ; Hiromitsu TOYODA ; Hidetomi TERAI ; Hiroaki NAKAMURA
Asian Spine Journal 2021;15(4):472-480
Methods:
We investigated 154 foramina at L5–S1 in 77 patients. All the patients had degenerative lumbar disorders and had undergone both conventional MRI and 3D-MRI during the same visit. Differences between the FSRs calculated from conventional and 3D-MRI reconstructions and any correlations with the plain radiography findings were assessed.
Results:
In foramina that had a FSR of <50% on conventional MRI, the difference between the FSR obtained using conventional MRI and 3D-MRI was 5.1%, with a correlation coefficient of 0.777. For foramina with a FSR ≥50% on conventional MRI, the difference was 20.2%, with a correlation coefficient of 0.54. FSR obtained using 3D-MRI was significantly greater in patients who required surgery than in those who were successfully treated with conservative methods (88% and 42%, respectively). Segments with spondylolisthesis or lateral wedging showed higher FSRs than those without these conditions on both types of MRI.
Conclusions
FSRs <50% obtained using conventional MRI were sufficiently reliable; however, the results were inaccurate for FSRs ≥50%. Patients with high FSRs on 3D-MRI were more likely to require surgical treatment. Therefore, 3D-MRI is recommended in patients with suspected stenosis detected using conventional MRI or plain radiographs.
4.Prevalence of Diffuse Idiopathic Skeletal Hyperostosis in Patients with Spinal Disorders.
Hiromitsu TOYODA ; Hidetomi TERAI ; Kentaro YAMADA ; Akinobu SUZUKI ; Sho DOHZONO ; Tomiya MATSUMOTO ; Hiroaki NAKAMURA
Asian Spine Journal 2017;11(1):63-70
STUDY DESIGN: Retrospective cohort study. PURPOSE: The purpose of this study was to evaluate the prevalence of diffuse idiopathic skeletal hyperostosis (DISH) in patients with spinal diseases determined by roentgen images of the whole spine. OVERVIEW OF LITERATURE: Although several studies have investigated the prevalence of DISH in healthy subjects, no detailed data have been reported on the prevalence of DISH in patients with degenerative spinal disorders. METHODS: Standing whole-spine roentgen images of 345 consecutive patients who underwent surgery in our hospital were obtained. Patients aged <18 years or with congenital spinal disease, metastatic spinal tumors, or inflammatory spinal disease were excluded. In total, 281 patients were eligible for inclusion. The presence of DISH was assessed according to Resnick's criteria and Mata's scoring system. The prevalence, location, and numbers of fused vertebral bodies of DISH were recorded. RESULTS: DISH was present in 25.6% of patients (72/281). The prevalence of DISH in the 41–49, 50–59, 60–69, 70–79, and ≥80 year age groups was 8.3% (2/24), 9.8% (5/51), 16.0% (12/75), 49.5% (48/97), and 33.3% (4/12), respectively; the prevalence increased with age. The average number of fused vertebral bodies was 7.5. More than 80% of DISH was located from T7 to T11, and more than 95% of DISH was located at T9/10. Patients with DISH were significantly older (71.1 years vs. 60.9 years, p<0.05), and men were more likely to have DISH than women (p<0.05). CONCLUSIONS: In patients with degenerative spinal diseases with DISH, fused vertebrae were found most frequently in the lower thoracic spine, and their prevalence increased with age. DISH may be an age-related skeletal disorder with a higher overall prevalence in patients with spinal disorders than that in healthy subjects.
Cohort Studies
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Female
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Healthy Volunteers
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Humans
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Hyperostosis, Diffuse Idiopathic Skeletal*
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Male
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Prevalence*
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Retrospective Studies
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Spinal Diseases
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Spine
5.Atlantoaxial Stabilization Using C1 Lateral Mass and C2 Pedicle/Translaminar Screw Fixation by Intraoperative C1- and C2-Direct-Captured Navigation with Preoperative Computed Tomography Images
Yasunobu ITOH ; Ryo KITAGAWA ; Shinichi NUMAZAWA ; Kota YAMAKAWA ; Osamu YAMADA ; Isao AKASU ; Jun SAKAI ; Tomoko OTOMO ; Hirotaka YOSHIDA ; Kentaro MORI ; Sadayoshi WATANABE ; Kazuo WATANABE
Asian Spine Journal 2023;17(3):559-566
In C1–C2 posterior fixation, the C1 lateral mass and C2 pedicle/translaminar screw insertion under spine navigation have been used frequently. To avoid the risk of neurovascular damage in atlantoaxial stabilization, we assessed the safety and effectiveness of a preoperative computed tomography (CT) image-based navigation system with intraoperative independent C1 and C2 vertebral registration. It is ideal when a reference frame can be linked directly to the C1 posterior arch for C1-direct-captured navigation, but there is a mechanical challenge. A new spine clamp-tracker system was implemented recently, which allows reliable C1- and C2- direct-captured navigation in nine patients with traumatic C2 fractures. In this way, there was no misalignment of C1–C2 screws. C1 lateral mass screws were used except for one case, and translaminar screws were primarily used as an anchor for C2. The C1 lateral mass screw locations, which are 19 mm laterally from the C1 posterior arch’s center, are taken to be constant. However, there is one unusual circumstance in which using a C1 laminar hook instead of a C1 lateral mass screw appears to be a beneficial substitute. The increase of surgical accuracy for posterior C1–C2 screw fixation without cost constraints is significantly facilitated by intraoperative C1- and C2-direct-captured navigation with preoperative computed CT images.
6.Specificity of the meridians and acupuncture-points. Effects of qiuxu on the gallbladder's form.
Tadashi YANO ; Yoshiki OYAMA ; Nobuyuki YAMADA ; Kazu MORI ; Toshinori YUKIMACHI ; Shinichi FUSHITA ; Kentaro MAEDA ; Ryo KAWAMOTO ; Katsuhiko SHIMOYA ; Takao SHIBATA ; Shigeru IHARA ; Naoto HONTANI ; Katsutoshi GOTO ; Hiroshi NAKATA ; Misao OKIEBISU
Journal of the Japan Society of Acupuncture and Moxibustion 1990;40(4):343-350
Objective:
There have been a few reports on the specificity of the meridians and Acupuncture-points. In order to identify the specific effects of the meridians and Acupuncture-points, the functional relations between “the gallbladder Meridian and gallbladder” were investigated using the gallbladder's form as an index.
Materials and Methods:
Ten healthy male adult volunteers participated in the experiments in fasting conditions. The target organ was the gallbladder, and its form was measured with the ultrasonic diagnostic apparatus (Toshiba SSA-90A). The images of the gallbladder form were taken at the point when the major long axis of the cross-section of the gallbladder reached the peak. The cross-sectional area of the gallbladder was measured with the image analyzer. The measurement of the gallbladder form was conducted after 15 minutes lying on the back, taking images for 10 minutes before stimulation, for 30 minutes during and after stimulation, every two to five minutes. The acupuncture stimulation was given at the points of G34, G36, G37, G40 and G44 on the right side of the body. After getting the deqi, 1 minute of sparrow pecking needle technique and 1 minute of leaving needle technique were conducted three times. The effect of the G40 under the egg yolk loading were also investigated.
Results:
1) The stimulation of the G34, G36, G37, and G44 showed no effects on the gallbladder form. 2) The stimulation of the G40 caused the distension of the gallbladder form. 3) The stimulation of the G40 showed the suppressive effect on the contraction of the gallbladder due to the load of egg yolk.
As described above, the results of this study showed that there is an acupuncture-point on the gallbladder meridian to cause the distension of the gallbladder specifically. It suggests the existence of the specificity of acupuncture-point.
7.Clinicopathologic features, treatment, prognosis and prognostic factors of neuroendocrine carcinoma of the endometrium: a retrospective analysis of 42 cases from the Kansai Clinical Oncology Group/Intergroup study in Japan
Harunobu MATSUMOTO ; Mototsugu SHIMOKAWA ; Kaei NASU ; Ayumi SHIKAMA ; Takaya SHIOZAKI ; Masayuki FUTAGAMI ; Kentaro KAI ; Hiroaki NAGANO ; Taisuke MORI ; Mitsutake YANO ; Norihiro SUGINO ; Etsuko FUJIMOTO ; Norihito YOSHIOKA ; Satoshi NAKAGAWA ; Muneaki SHIMADA ; Hideki TOKUNAGA ; Yuki YAMADA ; Tomohiko TSURUTA ; Kazuto TASAKI ; Ryutaro NISHIKAWA ; Shiho KUJI ; Takashi MOTOHASHI ; Kimihiko ITO ; Takashi YAMADA ; Norihiro TERAMOTO
Journal of Gynecologic Oncology 2019;30(6):e103-
OBJECTIVE: We conducted a retrospective, multi-institutional, collaborative study to accumulate cases of neuroendocrine carcinoma of the endometrium, to clarify its clinicopathologic features, treatment, prognosis and prognostic factors to collate findings to establish future individualized treatment regimens. To our knowledge, this is the largest case study and the first study to statistically analyze the prognosis of this disease. METHODS: At medical institutions participating in the Kansai Clinical Oncology Group/Intergroup, cases diagnosed at a central pathologic review as neuroendocrine carcinoma of the endometrium between 1995 and 2014 were enrolled. We retrospectively analyzed the clinicopathologic features, treatment, prognosis and prognostic factors of this disease. RESULTS: A total of 65 cases were registered from 18 medical institutions in Japan. Of these, 42 (64.6%) cases were diagnosed as neuroendocrine carcinoma of the endometrium based on the central pathological review and thus included in the study. Advanced International Federation of Gynecology and Obstetrics stages (stage III and IV) and pure type small cell neuroendocrine carcinoma cases had a significantly worse prognosis. Upon multivariate analysis, only histologic subtypes and surgery were significant prognostic factors. Pure type cases had a significantly worse prognosis compared to mixed type cases and complete surgery cases had a significantly better prognosis compared to cases with no or incomplete surgery. CONCLUSION: Our findings suggest that complete surgery improves the prognosis of neuroendocrine carcinoma of the endometrium. Even among cases with advanced disease stages, if complete surgery is expected to be achieved, clinicians should consider curative surgery to improve the prognosis of neuroendocrine carcinoma of the endometrium.
Carcinoma, Large Cell
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Carcinoma, Neuroendocrine
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Carcinoma, Small Cell
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Endometrial Neoplasms
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Endometrium
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Female
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Gynecology
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Japan
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Medical Oncology
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Multivariate Analysis
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Obstetrics
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Prognosis
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Retrospective Studies