1.EFFECTS OF PRIMARY PREVENTION ON MEDICAL ECONOMICS
TAKESHI KAWAGUCHI ; YOSHIKI KAMIYAMA
Japanese Journal of Physical Fitness and Sports Medicine 2003;52(Supplement):93-96
The health service system in Japan has changed remarkably in the past 20 years. One feature of the changes is the introduction of evidence-based medicine (EBM) and another is medical economics. These approaches were not taken into account in the health services though they were very common in economic work. The rapidly aging population and economic crisis call for a new evaluation system in the health service field in Japan.
There are some studies on medical economics in clinical services at present; however few studies have been reported in preventive medicine. Especially, studies on medical economics in prim ary prevention in the community are very few in our country.
The activity of primary prevention is very important not only for medical economics but also for health promotion which is represented by The Healthy Japan 21. This article introduces some studies on medical economics for prevention in the United States and European Countries as well as some reports in the fields of industrial health in Japan.
Regretfully, only one study on medical economics has been found in the community; however this study did not show enough reliability and validity epidemiologically.
Kuno and his group conducted a new primary prevention study for aged people in a community. And medical economic evaluation programs are induced from the beginning in each project. These results may have a strong influence on primary prevention work in the community in Japan.
2.Successful Surgical Treatment of Traumatic Rupture of the Descending Aorta in a Child
Takeshi Yuasa ; Leo Kawaguchi ; Yasuhisa Ohara ; Kenzo Yasuura
Japanese Journal of Cardiovascular Surgery 2006;35(4):242-245
Traumatic rupture of the thoracic aorta is extremely rare in pediatric patients. We present a case of blunt traumatic aortic disruption in a 13-year-old boy who was successfully managed by patch aortoplasty using cardiopulmonary bypass. He was involved in a motor vehicle accident. He had a transient loss of consciousness. Initial vital signs were stable. Upon arrival at our hospital he was awake, alert, and oriented. Chest roentgenogram showed a subtly widened upper mediastinum with left pleural effusion. Chest computed tomography revealed a hematoma around the transverse and proximal descending thoracic aorta, and a 25-mm pseudoaneurysm with the intimal flap in the proximal descending thoracic aorta. Aortography verified a partial transection of the proximal descending aorta. Within 4h after injury, aortic repair was initiated through a left anterolateral thoracotomy. Following heparinization, partial cardiopulmonary bypass was established via the right femoral artery and vein. Sequential occlusion of the left subclavian artery, aortic arch between the left carotid and subclavian arteries, and descending aorta was performed. The periaortic hematoma was incised longitudinally to show a transverse tear involving the anterolateral aortic wall 3cm distal to the origin of the left subclavian artery. The disruption involved approximately 90% of the circumference of the aortic wall and there was retraction of the torn edges. A half of the impaired aorta was sutured, primarily to accommodate future aortic growth, and the other half of the defect was closed with a prosthetic patch. Bypass time was 173min. The postoperative course was complicated by persistent low-grade fever and hoarseness. Four years following discharge, he was well with only slight hoarseness, and magnetic resonance angiography two years later demonstrated a normal aorta without clinical evidence of coarctation.
3.EFFECT OF MUSCLE EXERCISE ON REDUCTION IN MEDICAL EXPENDITURE AMONG ELDERLY
YOSHIKI KAMIYAMA ; TAKESHI KAWAGUCHI ; AKIRA KANDA ; SHINYA KUNO ; TAKAHIKO NISHIJIMA
Japanese Journal of Physical Fitness and Sports Medicine 2004;53(2):205-209
In order to study the effect of muscle exercise on the medical expenditure of the elderly, a three-year exercise program focusing on muscle activity was performed by an intervention group. Individual yearly medical expenditures were collected by 20 participants of the exercise group aver aging 65.2 years of age and 23 control subjects averaging 68.4 years of age with National Health Insurance coverage. Yearly medical expenditures for the exercise group were significantly lower than those of the control group at one and two years after entry. The expenditures increased by 62.6% from 1997 to 1999 in the control group, whereas they increased by only 16.8% for the exer cise group. The results suggest the possibility of the effectiveness of muscle exercise on the reduction in medical expenditure among the elderly.
4.Minimum 10-Year Follow-up Study of Anterior Lumbar Interbody Fusion for Degenerative Spondylolisthesis: Progressive Pattern of the Adjacent Disc Degeneration.
Masahiko KANAMORI ; Taketoshi YASUDA ; Takeshi HORI ; Kayo SUZUKI ; Yoshiharu KAWAGUCHI
Asian Spine Journal 2012;6(2):105-114
STUDY DESIGN: Retrospective study. PURPOSE: The aims of the current study are to evaluate the minimum 10-year follow-up clinical results of anterior lumbar interbody fusion (ALIF) for degenerative spondylolisthesis. OVERVIEW OF LITERATURE: ALIF has been widely used as a treatment regimen in the management of lumbar spondylolisthesis. Still much controversy exists regarding the factors that affect the postoperative clinical outcomes. METHODS: The author performed a retrospective review of 20 patients with degenerative spondylolisthesis treated with ALIF (follow-up, 16.4 years). The clinical results were assessed by the Japanese Orthopaedic Association (JOA) score for low back pain, vertebral slip and disc height index on the radiographs. RESULTS: The mean preoperative JOA score was 7.1 +/- 1.8 points (15-point-method). At 1 year, 5 years, and 10 years or more after surgery, the JOA scores were assessed as 12.4 +/- 2.2 points, 12.7 +/- 2.6 points, 12.0 +/- 2.5 points, respectively (excluding the data of reoperated cases). The adjacent disc degeneration developed in all cases during the long-term follow-up. The progressive pattern of disc degeneration was divided into three types. Initially, disc degeneration occurred due to disc space narrowing. After that, the intervertebral discs showed segmental instability with translation at the upper level. But the lower discs showed osteophyte formation, and occasionally lead to the collapse or spontaneous union. CONCLUSIONS: The clinical results of the long-term follow-up data after ALIF became worse due to the adjacent disc degeneration. The progressive pattern of disc degeneration was different according to the adjacent levels.
Asian Continental Ancestry Group
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Follow-Up Studies
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Humans
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Intervertebral Disc
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Intervertebral Disc Degeneration
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Intervertebral Disc Displacement
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Low Back Pain
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Lumbosacral Region
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Osteophyte
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Retrospective Studies
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Spondylolisthesis
5.Lumbar Spinal Stenosis Due to a Large Calcified Mass in the Ligamentum Flavum.
Shoji SEKI ; Yoshiharu KAWAGUCHI ; Hirokazu ISHIHARA ; Takeshi OYA ; Tomoatsu KIMURA
Asian Spine Journal 2013;7(3):236-241
We describe a rare case of lumbar spinal stenosis due to a large calcified mass in the ligamentum flavum. This patient presented with a 12-month history of severe right leg pain and intermittent claudication. A computed tomography scan was performed, revealing a large calcified mass on the ligamentum flavum at the right-hand side of the lumbar spinal canal. We performed a laminotomy at the L4/5 level with resection of the calcified mass from the ligamentum flavum. The findings of various analyses suggested that the calcified mass consisted mostly of Ca3(PO4)2 and calcium phosphate intermixed with protein and water. The calcified mass in the ligamentum flavum was causing lumbar spinal stenosis. Surgical decompression by resection of the mass was effective in this patient. The calcified material was composed mainly of elements derived from calcium phosphate. Degenerative changes in the ligamentum flavum of the lumbar spine may have been involved in the production of this calcified mass.
Calcium
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Calcium Phosphates
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Decompression, Surgical
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Humans
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Intermittent Claudication
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Laminectomy
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Leg
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Ligamentum Flavum
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Spinal Canal
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Spinal Stenosis
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Spine
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Water
6.Comparison of an Accelerometer-Based Portable Navigation System, Patient-Specific Instrumentation, and Conventional Instrumentation for Femoral Alignment in Total Knee Arthroplasty
Kohei KAWAGUCHI ; Kazuhiko MICHISHITA ; Takeshi MANABE ; Yoshiyuki AKASAKA ; Junya HIGUCHI
The Journal of Korean Knee Society 2017;29(4):269-275
PURPOSE: The KneeAlign2 (KA2, OrthoAlign Inc.) accelerometer-based portable navigation system and patient-specific instrumentation (PSI; Signature, ZimmerBiomet) are widely used for ideal femoral component alignment in total knee arthroplasty (TKA). However, there has been no comparative study of the KA2 system, PSI, and conventional intramedullary instrumentation (CON). The purpose of this study was to compare the accuracy in achieving proper femoral component alignment and clinical features by using the KA2 navigation system, PSI, and CON. MATERIALS AND METHODS: We retrospectively compared the accuracy of femoral component alignment of 34 TKAs performed with the KA2 system for implantation of the femoral component, 32 TKAs with PSI, and 33 TKAs with CON. RESULTS: In the coronal plane, use of the KA2 system was more likely to result in optimal femoral component alignment than the CON and PSI (p < 0.01). In the sagittal plane, use of the KA2 system was more likely to result in optimal component alignment than PSI, but the difference between the KA2 and CON was insignificant. CONCLUSIONS: The portable accelerometer-based KA2 navigation system enabled ideal femoral implantation in the coronal and sagittal planes, as compared to the PSI or CON.
Arthroplasty
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Arthroplasty, Replacement, Knee
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Knee
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Retrospective Studies
7.Metastatic Skin Carcinoma.
Hidetsugu SATO ; Seigo HIGASHI ; Jun YAMAGUCHI ; Kazumi TSUJINO ; Shuichi INABA ; Takashi YOSHIKAWA ; Tsuguo TERAI ; Yoshiaki SEKISHITA ; Masaru FUJIMORI ; Tsuneo SHIONO ; Shinjuro KUROSHIMA ; Norihiko TSUMURA ; Isao KAWAGUCHI ; Takeshi NISHIOKA ; Hiroki SHIRATO ; Kazuaki TAKAHASHI ; Shigeo SAKASHITA ; Masanobu KUMAKIRI
Journal of the Japanese Association of Rural Medicine 1994;43(4):964-968
We reported nine cases of metastatic skin carcinoma experienced at the Department of Dermatology, Obihiro Kosei Hospital during the period from April 1991 to March 1993. Lung was the most common primary lesion (four out of nine cases), followed by uterus (two) and stomach, breast, and kidney (one each). The clinical features of the metastases were classified into nodular (five cases), inflammatory (one case) and sclerotic (three cases) types. Peculiar zoster-like inflammation was seen in metastatic gastric cancer. Pathologically, adenocarcinoma was more common than squamous cell carcinoma. The average interval between the diagnosis of the primary cancers and the development of the skin metastases was about 30±25 months. The average life span after the detection of the skin metastases was 6.8±5.6 months. Poor prognosis of skin metastasis was thus reconfirmed.
8.Influence of body fat in cancer patients on residual content of used fentanyl matrix patches
Takeshi Chiba ; Yusuke Kimura ; Hiroaki Takahashi ; Tomohiko Tairabune ; Yoshiaki Nagasawa ; Kaoru Mori ; Yuji Yonezawa ; Atsuko Sugawara ; Sachiko Kawaguchi ; Hidenobu Kawamura ; Satoshi Nishizuka ; Kenzo Kudo ; Kunihiko Fujiwara ; Kenichiro Ikeda ; Go Wakabayashi ; Katsuo Takahashi
Palliative Care Research 2010;5(2):206-212
Purpose: The objective of this study was to investigate whether body fat rate (BFR) and triceps skinfold thickness (TSF) are associated with estimated fentanyl absorption in patients treated with the fentanyl transdermal matrix patch for moderate to severe cancer pain, by measuring the residual content of fentanyl in used matrix patches. Methods: Adult Japanese inpatients experiencing chronic cancer-related pain and receiving treatment for the first time with a transdermal fentanyl matrix patch (Durotep®MT patch) were included in the present study. During the initial application period, BFR was measured using a body fat scale, and TSF was measured by an experienced nurse with an adipometer. One patch was collected from each patient. The residual fentanyl content in used matrix patch was determined by high-performance liquid chromatography. The transdermal fentanyl delivery efficiency was estimated based on the fentanyl content of the used matrix patches. Results: Fifteen adult patients (5 males and 10 females) were included in this study. Nine patches with a release rate of 12.5μg/h and 6 patches with a release rate of 25μg/h were collected. The application site was the chest or upper arm. BFR and TSF both showed a significant positive correlation with delivery efficiency. Conclusion: In malnourished or low-body fat patients receiving DMP, pain intensity should be more carefully monitored, and fentanyl dose adjustment may be required. Additional parameters, such as nutritional status including body fat change, the degree of dry skin, and plasma fentanyl concentration, also require detailed evaluation. Palliat Care Res 2010; 5(2): 206-212
9.PainVision Apparatus Is Effective for Assessing Low Back Pain.
Seiji OHTORI ; Hiroshi KAWAGUCHI ; Tsuneo TAKEBAYASHI ; Sumihisa ORITA ; Gen INOUE ; Kazuyo YAMAUCHI ; Yasuchika AOKI ; Junichi NAKAMURA ; Tetsuhiro ISHIKAWA ; Masayuki MIYAGI ; Hiroto KAMODA ; Miyako SUZUKI ; Gou KUBOTA ; Yoshihiro SAKUMA ; Yasuhiro OIKAWA ; Kazuhide INAGE ; Takeshi SAINOH ; Jun SATO ; Kazuhisa TAKAHASHI ; Shinichi KONNO
Asian Spine Journal 2014;8(6):793-798
STUDY DESIGN: Case series. PURPOSE: To determine the utility of "PainVision" apparatus for the assessment of low back pain. OVERVIEW OF LITERATURE: A newly developed device, the PainVision PS-2100 (Nipro, Osaka, Japan), has been used to assess the perception of pain in a quantitative manner. In the current study, we aimed to evaluate the efficacy of PainVision for the assessment of low back pain. METHODS: We assessed 89 patients with low back pain. The numeric rating scale (NRS) score, McGill Pain Questionnaire (MPQ) score and the degree of pain calculated by PainVision were measured twice at 4-week intervals in each patient. An electrode was patched on the forearm surface of the patients and the degree of pain was automatically calculated (degree of pain=100x[current producing pain comparable with low back pain-current at perception threshold/current at perception threshold]). Correlations between NRS and MPQ scores and the degree of pain were determined using Spearman's rank correlation test. RESULTS: There was a strong correlation between the NRS and MPQ scores at each time point (rs =0.60, p<0.0001). The degree of pain also showed a moderate correlation with NRS and MPQ scores at each time point (rs =0.40, p<0.03). The change in the degree of pain over 4 weeks showed a moderate correlation with changes in the NRS and MPQ scores (rs =0.40, p<0.01). CONCLUSIONS: PainVision as self-reported questionnaires is a useful tool to assess low back pain.
Electrodes
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Forearm
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Humans
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Low Back Pain*
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Pain Measurement
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Surveys and Questionnaires
10.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.