1.Increased Cooperation with Dentistry by the Palliative Care Team
Hideaki Kawabata ; Masanori Nishikawa ; Hirosato Inoda ; Akio Tanaka ; Naoki Kakihara ; Chiaki Taga ; Mutsumi Kohigashi ; Mitsuo Nakamura ; Chisa Hasegawa ; Eiichiro Kanda ; Masako Nishimura ; Yukari Nakagawa ; Yoko Nishitani ; Mariko Nose ; Kota Asano ; Miwa Sakuma ; Keiko Fujimura
Palliative Care Research 2016;11(1):901-905
Recently, the palliative care team (PCT) at our hospital has included dentists. Among a total of 127 cancer patientsand required PCT intervention from 2009 to 2014, 17 patients (13.3%) had oral symptoms. Therefore, the PCT held discussions in order to determine the optimal way to treat each patient. Various symptoms, including oral pain, dry mouth, taste disturbance, furred tongue, excessive amounts of saliva, appetite loss, and trismus were treated by the dentists. As a result, the oral findings improved in all patients, while the oral symptoms improved in 16 of the 17 patients (94%). Thanks to the fact that dentists have joined the PCT, oral symptoms are effectively relieved, and PCT members now have an increased interest in oral cavity complications. Furthermore, conducting thorough examinations of the oral cavity by the PCT not only results in an improved QOL, but it has also increased the interest in the oral cavity on the part of the PCT. Therefore, more effective palliative care is expected to be achieved by promoting increased cooperation with more clinical departments.
2.Effectiveness of Duloxetine for Postsurgical Chronic Neuropathic Disorders after Spine and Spinal Cord Surgery
Osahiio TSUJI ; Shizuko KOSUGI ; Satoshi SUZUKI ; Satoshi NORI ; Narihito NAGOSHI ; Eijiro OKADA ; Nobuyuki FUJITA ; Mitsuru YAGI ; Masaya NAKAMURA ; Morio MATSUMOTO ; Kota WATANABE
Asian Spine Journal 2021;15(5):650-658
Methods:
A total of 24 patients with postsurgical chronic pain and/or numbness Numeric Rating Scale (NRS) scores of ≥4 were enrolled. All patients underwent spine or spinal cord surgery at Keio University Hospital and received daily administration of DLX for more than 3 months. The mean postoperative period before the first administration of DLX was 35.5±57.0 months. DLX was administered for more than 3 months at a dose of 20, 40, or 60 mg/day, and the degree of pain and numbness was evaluated using the NRS before administration and 3 months after administration. Effectiveness was defined as more than a 2-point decrease in the NRS score following administration.
Results:
In terms of the type of symptoms, 15 patients experienced only numbness, eight experienced both pain and numbness, and one experienced only pain. Of the 24 patients, 19 achieved effective relief with DLX. DLX was effective for all patients with postsurgical chronic pain (n=9), and it reduced postsurgical chronic numbness in 18 of 23 patients. No significant difference was observed in background spinal disorders. DLX was not effective for five patients who complained only of postsurgical chronic numbness.
Conclusions
This study reports the effectiveness of DLX for postsurgical chronic neuropathic disorders. Although DLX reduced postsurgical chronic pain (efficacy rate=100%) and numbness (78.3%) in certain patients, further investigation is needed to determine its optimal use.
3.Coronal Plane Gap Increases Postoperative Pseudoarthrosis after Lateral Interbody Fusion for Adult Spinal Deformity
Eijiro OKADA ; Mitsuru YAGI ; Yusuke YAMAMOTO ; Satoshi SUZUKI ; Satoshi NORI ; Osahiko TSUJI ; Narihito NAGOSHI ; Nobuyuki FUJITA ; Masaya NAKAMURA ; Morio MATSUMOTO ; Kota WATANABE
Asian Spine Journal 2022;16(3):386-393
Methods:
This study included 42 patients with ASD (two men and 40 women; 112 segments; mean, 68.5±8.4 years; and mean follow-up, 31.6±17.0 months) who underwent LIF and posterior correction surgery. The concave slot of the LIF cage was filled with an autologous iliac crest bone graft (IBG), and the convex slot with a porous hydroxyapatite/collagen (HAp/Col) composite was soaked with bone marrow aspirate. Endplate injury, the gap between vertebral endplate and cage in the coronal or sagittal plane, and fusion status were evaluated using computed tomography multiplanar reconstruction at 12 months after surgery. Moreover, the associated risk factors for pseudoarthrosis were analyzed.
Results:
Fusion at LIF segments were observed in 71.4% segments at 12 months after surgery. Fusion on the concave slot (autologous IBG side), convex slot (porous HAp/Col composite side), and both concave and convex slots were observed in 66.1%, 37.5%, and 36.6% of patients, respectively. Moreover, pseudoarthrosis was observed in 28.6% at 12 months after surgery. Consequently, logistic regression analysis of the fusion at the LIF segment revealed that the gap between the LIF cage and endplate in the coronal plane (p=0.030; odds ratio, 0.183; 95% confidence interval, 0.030–0.183) was significantly associated with pseudoarthrosis at the LIF segments.
Conclusions
ASD surgery fusion rate using LIF cages was 71.4% at 12 months after surgery. The fusion rate was higher on the concave slot filled with autologous IBG than on the convex slot filled with a porous HAp/Col composite. The gap in the coronal plane was a risk factor for pseudoarthrosis at the LIF segment.
4.Early Phase Functional Recovery after Spinal Intramedullary Tumor Resection Could Predict Ambulatory Capacity at 1 Year after Surgery
Tetsuya SUZUKI ; Osahiko TSUJI ; Masahiko ICHIKAWA ; Ryota ISHII ; Narihito NAGOSHI ; Michiyuki KAWAKAMI ; Kota WATANABE ; Morio MATSUMOTO ; Tetsuya TSUJI ; Toshiyuki FUJIWARA ; Masaya NAKAMURA
Asian Spine Journal 2023;17(2):355-364
Results:
In the early phase after surgery, 71% and 43% of the participants were nonindependent ambulators at 1W and 2W, respectively. Histopathology indicated that patients with solid tumors (ependymoma, astrocytoma, or lipoma) showed significantly lower indices at 1W and 2W than those with vascular tumors (hemangioblastoma or cavernous hemangioma). Regarding tumor location, thoracic cases exhibited poorer lower-limb function at 1W and 2W and poorer walking ability at 2W than cervical cases. According to the receiver operating characteristic (ROC) analysis, 2 WISCI II points at 2W had the highest sensitivity (100%) and specificity (92.2%) in predicting the level of walking independence at 1 year postoperatively (the area under the ROC curve was 0.99 (95% confidence interval, 0.93–1.00).
Conclusions
The higher the lower-limb function scores in the early phase, the better the improvement in walking ability is predicted 1 year after ISCT resection.
5.Poor Prognostic Factors for Surgical Treatment of Spinal Intramedullary Ependymoma (World Health Organization Grade II)
Osahiko TSUJI ; Narihito NAGOSHI ; Ryota ISHII ; Satoshi NORI ; Satoshi SUZUKI ; Eijiro OKADA ; Nobuyuki FUJITA ; Mitsuru YAGI ; Morio MATSUMOTO ; Masaya NAKAMURA ; Kota WATANABE
Asian Spine Journal 2020;14(6):821-828
Methods:
Eighty patients who underwent surgical resection at Keio University and Fujita Health University in Tokyo, Japan between 2003 and 2015 with more than 2 years of follow-up were enrolled. A good surgical result was defined as an improvement in the modified McCormick Scale score by one grade or more or having the same clinical grade as was observed preoperatively. Meanwhile, a poor result was defined as a reduction in the McCormick Scale score of one grade or more or remaining in grade IV or V at final follow-up. Univariate and multivariate logistic regression analyses of the following factors were performed in the two groups: sex, age, preoperative Visual Analog Scale (VAS), tumor location, the extent of tumor resection, hemosiderin caps, cavity length, and tumor length on magnetic resonance imaging.
Results:
At final follow-up, 15 patients were included in the poor results group and 65 in the good results group. In the univariate analysis, the factors related to poor results were as follows: higher age, preoperative McCormick Scale score severity, higher preoperative VAS, thoracic location, hemosiderin capped, and non-gross total resection (GTR). A multiple logistic regression analysis was conducted and showed that age, worse preoperative McCormick Scale score, and non-GTR were significant factors for poor prognosis.
Conclusions
The independent risk factors for motor deterioration after ependymoma resection were age, worse preoperative McCormick Scale score, and non-GTR. Early surgery for patients with even mild neurological disorders could facilitate functional outcomes. These results may contribute to determining the optimal timing of surgery for spinal intramedullary ependymoma.
6.Closure of Oronasal Fistulae Post Palatoraphy with Tongue Flap in Bilateral Complete Cleft Lip Palate Patient: A Case Report
Menik Sayekti ; Liska Barus ; Ni Putu Mira Sumarta ; Norifumi Nakamura
Archives of Orofacial Sciences 2021;16(SUPP 1):59-65
ABSTRACT
Oronasal fistulae are common complication following palatoraphy. There are several surgical procedures
to repair oronasal fistulae. However, conventional oronasal fistulae closure technique is not always
possible, especially when the surrounding tissue is replaced by fibrotic tissue due to previous palatoraphy.
Tissue defects in oronasal fistulae should be replaced with tissues providing good vascularisation
such as pedicle tongue flap. A case of pedicle tongue flap used to close oronasal fistulae was reported.
Eleven-year-old girl, presented with oronasal fistulae and bilateral alveolar cleft after previous
palatoraphy. The oronasal fistulae were closed with pedicled tongue flap. The healing was uneventful,
and the division of the pedicle tongue flap was done three weeks later and closed primarily. There was
no dehiscence of the wound and masticatory functions were recorded. Vascularised flap such as pedicle
tongue flap is a preferred technique to close oronasal fistulae after palatoraphy.
Dental Fistula
;
Surgical Flaps
7.Transcranial Magnetic Stimulation for Neuropathic Pain with Motor Weakness Caused by Spine Orthodontic Fixation
Kota NAKAMURA ; Shuntaro KAWAGUCHI ; Takeshi KOBAYASHI ; Tomohito SATO ; Yutaro ASAKURA ; Takamitsu YAMAMOTO
The Japanese Journal of Rehabilitation Medicine 2002;():21036-
An 81-year-old woman sustained a fracture of the vertebra, resulting in grace deformation. After surgery for the spinal fixation, she suffered from left femoral neuropathic pain and motor weakness of both lower extremities. Daily repetitive transcranial magnetic stimulation (rTMS) of the lower extremity area in the right motor cortex was applied using a figure-8 coil connected to a magnetic stimulator (MagPro R30;Nagventure).One thousand pulses per session were delivered (10 trains of 10Hz for 10 seconds with 25-seconds intertrain interval) in one day, and this treatment continued for 2 weeks except Sunday. The intensity of rTMS was set at the resting motor threshold for that day. rTMS together with physical therapy resulted in a remarkable amelioration of the femoral pain and motor weakness of both lower extremities. Pain on a Visual Analogue Scale dropped from 70% to 22%, and walking speed and walking rate increased. Functional Independence Measure score increased from 58 to 79, and Euro QOL 5 score increased from 0.419 to 0.768. As previously reported in cases of post-stroke pain and motor weakness, rTMS together with physical therapy exerted measurable beneficial effects on intractable pain and motor weakness caused by spinal orthodontic fixation.
8.Acquired Left Ventricle to Right Atrial Communication Following Infective Endocarditis of the Native Aortic Valve Diagnosed Using Cardiac Computed Tomography
Mizuho IKUCHI ; Kentaro HONDA ; Kota AGEMATSU ; Hideki KUNIMOTO ; Ryo NAKAMURA ; Koji TAJIMA ; Masahiro KANEKO ; Yoshiharu NISHIMURA
Japanese Journal of Cardiovascular Surgery 2023;52(1):14-17
Left ventricle to right atrial communication is a rare cardiac pathology, and it is either congenital or acquired. Recently, case reports of acquired left ventricle to right atrial communication have been increasing because of the increased numbers of cardiovascular procedures and improved cardiac diagnostic techniques. We report a case of acquired left ventricle to right atrial communication in a patient with native aortic valve infective endocarditis. A 52-year-old man with worsening dyspnea on exertion and lower leg edema was admitted to a hospital. Blood examination revealed elevated inflammatory marker levels, and transthoracic echocardiography (TTE) showed an aortic valve vegetation. The patient was subsequently transferred to our hospital for infective endocarditis with congestive heart failure. Medical treatment with antibiotics and diuretics was initiated. Cardiac computed tomography (CT) demonstrated left ventricle to right atrial communication. An urgent operation was performed wherein the defect was closed with autologous pericardial patches from both the right atrium and left ventricle. Aortic valve replacement was performed with a mechanical valve. The postoperative course was uneventful, and TTE showed no residual shunt. In our case, cardiac CT was useful for accurately diagnosing left ventricle to right atrial communication.
9.Prognostic factors for candidaemia in intensive care unit patients: a retrospective analysis.
Yasumasa KAWANO ; Atsushi TOGAWA ; Yoshihiko NAKAMURA ; Mariko MIZUNUMA ; Reiko YAMASAKI ; Kota HOSHINO ; Takeshi NISHIDA ; Hiroyasu ISHIKURA
Singapore medical journal 2017;58(4):196-200
INTRODUCTIONCandidaemia, recognised as a fairly common disease among intensive care unit (ICU) patients, carries a poor prognosis. However, as studies on the prognostic factors associated with candidaemia in ICU patients are limited, this study aimed to establish the best prognostic factor for ICU patients with candidaemia in a tertiary care hospital in Japan.
METHODSWe conducted a retrospective cohort study of patients with candidaemia in the emergency ICU at Fukuoka University Hospital, Fukuoka, Japan, from April 2010 to March 2015. Demographic and clinical data was collected from the patients' medical records and laboratory databases.
RESULTSA total of 25 patients were included in the study. However, 18 patients died during hospitalisation, resulting in an in-hospital mortality rate of 72.0%. The variables of Sequential Organ Failure Assessment (SOFA) score and cumulative number of risk factors for invasive candidiasis showed significant differences between patients in the survivor and non-survivor groups (p < 0.05). The areas under the receiver operating characteristic curves for the SOFA score and cumulative number of risk factors for invasive candidiasis were 0.873 (95% confidence interval [CI] 0.72-1.00) and 0.937 (95% CI 0.84-1.00), respectively.
CONCLUSIONOur results suggest that the cumulative number of risk factors for invasive candidiasis was the most useful prognostic indicator for candidaemia in ICU patients.