4.Aortic Valve Reconstruction (AVrC) Using Autologous Pericardium for a Patient with Severe Aortic Stenosis and Chronic Renal Failure Prior to Kidney Transplant Surgery
Keisuke Watadani ; Naomichi Uchida ; Keijiro Katayama ; Shinya Takahashi ; Taiichi Takasaki ; Tatsuya Kurosaki ; Katsuhiko Imai ; Taijiro Sueda
Japanese Journal of Cardiovascular Surgery 2014;43(2):92-95
We performed aortic valve reconstruction (AVrC) using autologous pericardium for a patient with severe aortic stenosis and chronic renal failure, prior to kidney transplantation. The patient received kidney transplantation in the early phase after cardiac surgery. The case was a 61-year-old man with severe aortic valve stenosis who received dialysis due to chronic renal failure. We performed AVrC using autologous pericardium for the following reasons. Anticoagulant therapy is not desirable because of the need to perform kidney transplantation in the early phase after cardiac surgery. Implantation of prosthesis was not desirable because the patient requires oral immunosuppression therapy after kidney transplantation. There was no significant postoperative pressure gradient of the aortic valve orifice or aortic valve regurgitation (AR). The patient received kidney transplantation 113 days after surgery. AVrC using autologous pericardium was feasible for aortic stenosis patients in a patient waiting to receive kidney transplantation because anticoagulation therapy is not necessary after AVrC.
5.Differences in Background Factors and Functional Recovery during the Early Postoperative Period and Their Effect on the Variance in Gait Acquisition of Patients Undergoing Total Knee Arthroplasty
Tetsuya Amano ; Kotaro Tamari ; Shigehiro Uchida ; Hideyuki Ito ; Shigeharu Tanaka ; Shinya Morikawa ; Kenji Kawamura
The Japanese Journal of Rehabilitation Medicine 2016;53(9):723-731
Objective:The aim of this study was to examine the relationships between the timing of gait acquisition and the length of hospitalization, and to clarify the differences in background factors and functional recovery during the early postoperative period and their effect on the variability in gait acquisition.
Methods:We recruited 148 patients who underwent total knee arthroplasty (TKA) at three hospitals. The participants were divided into two groups on the basis of the number of days needed to achieve independent gait at ≤14 days after surgery (group A) and >14 days after surgery (group B). We compared the background factors between the two groups. Additionally, we compared the preoperative and postoperative function in each group.
Results:We observed a significant positive correlation between the number of days needed to achieve independent gait and the length of hospitalization. In group A, the significant background factors were younger age and higher preoperative activity level. In group A, compared with the level of preoperative function, the postoperative maximum knee extension angle on the operated side and pain had significantly improved. In both groups, the postoperative knee extensor strength on the operated side, knee extensor strength on the nonoperated side, knee flexion strength on the operated side, maximum knee flexion angle on the operated side, and walking speed were significantly reduced.
Conclusion:During early rehabilitation, it is necessary to consider the age and previous activities of patients. In addition, we suggest that early rehabilitation with a focus on reducing pain by alleviating inflammation and improving maximum knee extension angle on the operated side may be effective for fast acquisition of gait.
6.Identifying Muscle Weakness and Limited Ranges of Motion in Patients with Knee Osteoarthritis before Total Knee Arthroplasty
Tetsuya Amano ; Kotaro Tamari ; Shigehiro Uchida ; Hideyuki Ito ; Shigeharu Tanaka ; Shinya Morikawa ; Kenji Kawamura
The Japanese Journal of Rehabilitation Medicine 2017;54(5):384-391
Objective:To elucidate factors associated with physical function and clarify the actual condition of functional deterioration in patients with knee osteoarthritis (OA) prior to total knee arthroplasty (TKA).
Methods:We enrolled 467 patients with severe knee OA and preoperatively assessed the following parameters:background factors (sex, age, BMI, K-L grade, and pain) and physical function (muscle strength of knee extensors and flexors, and knee joint angles). A multiple regression analysis was performed to determine the relationship between the independent background factors and dependent physical functions. The median of preoperative function based on selected factors of physical function was calculated.
Results:Based on the multiple regression analysis, sex, BMI, K-L grade, and pain statistically significantly correlated with muscle strength of knee extensors and flexors. Sex and BMI statistically significantly correlated with knee joint flexion angle. K-L grade statistically significantly correlated with knee joint extension angle. The median of muscle strength for knee extension was 0.98/0.92 Nm/kg (Grade 3/Grade 4) for males and 0.70/0.59 Nm/kg for females. The median of muscle strength for knee flexion was 0.53/0.45 Nm/kg for males, 0.36/0.30 Nm/kg for females. The median for knee joint flexion angle was 130° for males and 120° for females. The median for knee joint extension angle was -5°/-10° (Grade 3/Grade 4).
Conclusion:We clarified the degree of muscle strength and range of motion before TKA in patients with knee OA. We believe that the findings obtained in this study will contribute to explaining the functional deterioration of patients with knee OA.
7.Acupuncture Therapy for Hypertension (I)
Terukazu UCHIDA ; Hideo FUJIWARA ; Toshiaki IMOTO ; Shigeki OKADA ; Keiko NAKAYAMA ; Hiromasa INOUE ; Noriko MAEDA ; Shinya ABE ; Sei FURUTANI ; Yoshitomo SHIOAKI ; Naohide KOBAYASHI ; Futomi KOSAKA
Journal of the Japan Society of Acupuncture and Moxibustion 1982;32(1):54-58
Introduction
Essential hypertension is one of the leading causes of hypertension; responsible for more than 90% of such cases. Diet cure or drug treatment are usually prescribed for this disease. We drew notice to the antihypertensive effects of acupuncture.
Method
Subjects were healthy persons as well as patients complainig of simple essential hypertension. According to the WHO method, they were divided into three groups, e. g. normal, limitaneus, hypertensive. In situ needles were inserted in the antihypertensive points of both auricular sides for one week.
Effect
This treatment gave immediate results in 70% of the limitaneus and hypertensive groups. There was no observable effect for the balance. A number of these subjects were obese; a factor to be considered.
Evaluation
This method is very uncomplex and takes but minimal amount of time to treat patients.
8.Gingyo Gedokusan vs Oseltamivir for the Treatment of Uncomplicated Influenza and Influenza-like illness : An Open-label Prospective Study
Kentaro Iwata ; Wataru Igarashi ; Midori Honjo ; Takashi Nishimoto ; Kyoko Shinya ; Akiko Makino ; Kazuo Mitani ; Yoshiko Tatsumi ; Hiroyuki Ninomiya ; Kumi Higasa ; Seiichiro Usuki ; Hiroki Kagawa ; Daisuke Uchida ; Kohei Takimoto ; Rei Suganaga ; Hiroo Matsuo ; Yuichiro Oba ; Mami Horigome ; Hideaki Oka ; Goh Ohji ; Yasuhisa Abe ; Hiroyuki Yoshida ; Shohiro Kinoshita ; Midori Hirai
General Medicine 2013;14(1):13-22
Background: Gingyo-gedoku-san (GGGS) is an herbal medicine approved for upper respiratory infections in Japan. We conducted an open-label, multi-center, prospective trial, comparing GGGS with oseltamivir in patients with influenza and influenza-like illness (ILI) as a pilot study.
Methods: Subjects were healthy persons aged between 16 and 40, and were enrolled from January 12, 2010 to March 24, 2011. Fifteen patients were enrolled in this trial (8 and 7 for GGGS and oseltamivir, respectively). RT-PCR was positive for pandemic influenza A (H1N1) in 10 patients. The patients were provided with either GGGS or oseltamivir for 5 days. The primary outcome was mortality and/or hospitalization 7 days after the initial diagnosis. Body temperature and other clinical characteristics were also evaluated.
Results: All patients recovered from illness without complication or hospitalization. The mean time to resolve symptoms for the GGGS and oseltamivir groups was 3.9 days and 3.3 days, respectively (p=0.43). The GGGS group appeared to have a smaller symptom score AUC than the oseltamivir group, (p=0.26). Time to recover activity level appeared to be shorter in the GGGS group (p=0.10), with shorter time to recover health status (p=0.02). Sub-group analysis on patients with positive PCR showed similar results between the two groups.
Conclusion: GGGS was associated with symptom improvements resembling oseltamivir for both influenza and ILI. Randomized controlled trials involving larger sample sizes are needed to confirm these results.