OBJECTIVE: To analyze association between urodynamic study (UDS) parameters and renal function in spinal cord injured (SCI) patients with neurogenic detrusor overactivity. METHODS: Patients with a suprasacral SCI, who underwent UDS and radioisotope renogram at least twice between January 1, 2006 and January 31, 2013, were included. UDS (cystometric capacity, reflex volume, compliance, and maximal detrusor pressure) and radioisotope renogram (total effective renal plasma flow [ERPF] of both kidneys) data were collected. The following were conducted to reanalyze any association between reflex volume and ERPF: initial and follow-up results of consecutive evaluations were compared; a mixed-model regression analysis to account for clustered data was conducted to evaluate the association between UDS parameters and ERPF; and finally, a mixed-model analysis type 3 test with data pairs, of which the first evaluation showed involuntary detrusor contraction. RESULTS: A total of 150 patients underwent 390 evaluations which were arranged into 240 pairs of consecutive evaluations, of which 171 had first evaluations with observed involuntary detrusor contraction. The following results were obtained: cystometric capacity was significantly larger and maximal detrusor pressure was significantly lower on follow-up; on univariate analysis, reflex volume and maximal detrusor pressure were significant, and multivariate analysis using these two parameters showed that maximal detrusor pressure is significantly associated with total ERPF; and no significant differences were observed. CONCLUSION: Maximal detrusor pressure should be closely monitored in the urologic management of neurogenic detrusor overactivity in SCI patients. The results also may serve as a reference for regular UDS follow-up.
Compliance ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Reflex ; Renal Plasma Flow ; Renal Plasma Flow, Effective ; Spinal Cord ; Spinal Cord Injuries* ; Urinary Bladder, Neurogenic ; Urodynamics*

A 65-year-old woman suffered from swollen parotid and submandibular glands in July 2005, and sicca of the eyes and oral cavity arose in October 2005. We diagnosed her as having Mikulicz's disease based on magnetic resonance imaging of the head, gallium scintigraphy, and a lip biopsy in June 2006. After prednisolone 10 mg/day was commenced, her salivary glands shrank slightly. Although the amount of prednisolone had been tapered to 7 mg/day by May 2007, her serum IgG rebounded. In January 2008, hachimijiogan extract granules 7.5 g/day were introduced. Swelling of the salivary glands disappeared and her serum IgG level decreased. In May 2008, the amount of prednisolone was tapered successfully to 6 mg/day. Mikulicz's disease is a corticosteroid-sensitive disease, but in this case steroid resistance made treatment difficult. Based on this case, we performed functional assays of P-glycoprotein with calcein-AM, which demonstrated that hachimijiogan can reverse drug resistance.
seconds ; mg/d ; Prednisolone ; Serum ; Effective

We report the case of a 46-year-old man with hypertension whose blood pressure decreased due to saiko-karyukotsuboreito consumption.The patient also presented with some symptoms that suggested autonomic imbalance. After consuming 7.5g/day of a spray-dried powder of saikokaryukotsuboreito (Tsumura & Co.) for 3 months, his blood pressure measured at office was considerably lower. Twenty-four hour ambulatory blood pressure monitoring revealed that the surge in morning blood pressure, which is considered to be a risk factor for cerebrovascular disease, diminished in addition to the 24-hour mean blood pressure. A postural test revealed that his autonomic balance, which had been in a sympathetic dominant state, was inversely inclined to a parasympathetic dominant state.Our case report suggests that saikokaryukotsuboreito acts on the autonomic nervous system, which in turn exerts an antihypertensive effect, and that this effect is helpful in lowering the blood pressure in hypertensive patients whose autonomic balance is impaired due to stress.
Blood Pressure ; Assessment of balance ; Hour ; Effective ; Equilibrium

We evaluated the clinical effects of acupuncture/moxibustion therapy in 7 patients with vertigo that was uncontrollable with western medicine. The observation period was 6-15 months. The 7 patients consisted of 1 male and 6 females aged 29-73 years (mean, 44.7 years). More than 4 courses or more of acupuncture/moxibustion treatment (acupuncture + warm moxibustion) were performed in each patient, and the effects were evaluated based on the results of a daily living disability questionnaire before and after treatment. In practice, these effects were classified into 4 grades (cure, improvement, no change, aggravation). Cure was observed in1patient, improvement in 5 patients, and no change in1patient, indicating this therapy was effective in 85% of the patients. None of the patients showed aggravation of their condition. In addition, no adverse effects were observed.Our results suggest that acupuncture/moxibustion therapy has certain effects on intractable vertigo. Therefore, in patients with vertigo who do not respond to western medical care, such as the administration of anti-vertigo drugs, a beneficial effect of acupuncture/moxibustion as a complementary therapy can be expected.
Acupuncture ; Therapeutic procedure ; Vertigo ; Patients ; Effective

The purpose of this report was to evaluate the effect of oral appliances (ORAP) on patients with obstructive sleep apnea syndrome (OSAS) patients and to examine problem with ORAP therapy. Five patients (3 men and 2 women) who had OSAS were treated by ORAP therapy. Each patient underwent polysomnography before and after ORAP therapy. Percutaneous arterial oxygen saturation (SpO2) and Apnea Hypopnea Index (AHI) were measured and were compared.SpO2 levels were decreased and AHI figures were increased after ORAP therapy. The results indicated ORAP therapy was an effective treatment for OSAS.
Therapeutic procedure ; Sleep Apnea, Obstructive ; Oral ; Effective ; Indexes

Purpose: Many types of antihistamines used for the treatment of allergic rhinitis induce drowsiness as a side effect. Whether or not patients taking the internal drugs know of this untoward effect is a matter of importance. Recently we conducted a questionnaire survey to know how many patients are aware of this.Method: The subjects were 257 patients who visited our hospital for treatment of alergic rhinitis and took the prescription from February through March this year. The patients filled in a questionnaire given at the window of the dispensary. All the participants in this survey gave their informed consent.Results: Effective replies (90.3%) were obtained from 232 patients (mean age: 53.5±17.5; sex: 85 males and 147 females). Of those respondents, 45 individuals (19.9%) said they did not know that the antihistamines produce drowsiness. Furthermore, the survey found that 24 out of the 45 individuals were actually taking the type of antihistamine that caused drowsiness and 21 individuals were not given any explanation of the side effect by their doctors. The patients said that if they knew of the side effect they would not have taken the medicine. Moreover, it was found that 10 out of the 21 patients drove their cars while they felt drowsy.Conclusions: The survey revealed the hard fact that the drowsiness as side reaction the patients might have after taking antihistamines was made light of. The findings brought home to us the importance of giving clear directions to the patients about the medicine and the precaution against the side effects.
Drowsiness ; Surveys ; Antihistamines ; adverse effects ; Effective

It is said that retrospection therapy is effective in stabilizing emotional states of the aged and alleviating or holding in check symptoms associated with senile dementia. In recent years, the extended care facility of Asuke General Hospital has become so crowed with old people with dementia that it has become increasingly difficult to hold annual events on schedule. With the aim of improving the inmates' mental as well as psychological conditions, we more recently tried a retrospection therapy on a group of eight old people consisting of one emotionally unstable person and seven persons suffering from senile dementia.The group therapy was performed after ushering the old people into a private room with soft BGM played. In such a relaxing atmosphere, the session began along with a certain theme. For assessing the effectiveness of the therapy, 1) DMAS, 2) MOSES and3) NM scale were used. Apparently it produced some desired effects in every participant. Thus, the retrospection therapy proved to be useful. However, the results obtained varied depending on the kind of assessment methods. From this, we have also learned that there would be a risk of making an error of judgment with one assessment table.
Therapeutic procedure ; Knowledge acquisition using a method of assessment ; Effective ; Senile dementia ; Elderly

OBJECTIVE: To evaluate the renal function by investigating the relationship among serum cystatin C, serum creatinine, creatinine clearance and the average of bilateral ERPF (effective renal plasma flow) ratio of the MAG3 renal scan for the spinal cord injured patients. METHOD: Seventy-one spinal cord injured patients who admitted to our department were evaluated from January 2004 to October 2004. Blood samples and 24-hour urine of all the subjects were collected for measuring serum cystatin C, serum creatinine and creatinine clearance. MAG3 renal scan was done for 47 subjects. Regression analysis and Pearson's correlation methods were utilized for statistical analysis. RESULTS: There was significant correlation between 1/cystatin C and creatinine clearance (p<0.001) and the correlation coefficient between 1/cystatin C vs. creatinine clearance (R= 0.552) was bigger than that between 1/creatinine and creatinine clearance (R=0.329). The reciprocal of cystatin C was positively correlated with the average of bilateral ERPF ratio of MAG3 renal scan (p=0.01), while there was no significant correlation between 1/creatinine and the average of bilateral ERPF ratio. CONCLUSION: Measurement of serum cystatin C is a useful and convenient method for the evaluation of renal function in spinal cord injured patients.
Creatinine ; Cystatin C* ; Humans ; Plasma ; Renal Plasma Flow, Effective ; Spinal Cord Injuries ; Spinal Cord*

Today, the circumstances surrounding the medical economy are severer than ever. Therefore, it is vitally important for a hospital to rationalize management and implement a labor-saving system drastically.In October 2000, Atsumi Hospital moved to a newly built complex. At that time, those sections and departments which do not have any direct relation to medical treatment and care were restructured and established a supply center in order to use human resources effectivily.Before the establishment of the supply center, we had reviewd simple, routine tasks such as ward nursing assistant services, office work and management itself. While introducing our hospital supply center in this paper, we compare efficiencies before and after the move to the new building and dwell on advantages of centralization of ward nursing services.The rearrangement of the personnel, materials and information has made it possible to increase the efficiency of simple work and reduce the number of nursing assistants by 20%. Henceforth, it would be necessary to educate the staff, work on proper personnel changes, carefully make a plan for outsourcing, and choose trustworthy dealers.
Human Resources ; Work ; Economic supply ; Effective ; Central

As a management improvement tool useful for cost containment and adaptable to the trend of reform in recent years, we introduced the SPD system of medical materials. Since there had been no precedent for the introduction of the SPD system in the hospitals affiliated with Kouseiren and even for the dealer it was the first trial, an original system was built. The quantity of materials in stock was fixed by entrusting, so-called the shelf control system. This system has been left in charge of one hospital employee and one individual employed by the dealer.The condition at the time when this system was introduced was not to increase personnel but to lower costs. The maintenance costs of this system were as cheap as 137,700 yen per month on a five-year lease. As a result, the quantity of inventory at the time of the term-end settlement of accounts reduced by about 18 million yen. Moreover, in marked contrast with increased income, the amount of money expended in the purchase of medical materials decreased from that in the pervious year. Though the number of items used in each department has increased by 480 items now from the start, the inventory is 0 yen.This system is very useful especially for the inventory management of specific insurance medical materials, because it can take in insurance claim data on MO (Magneto Optical Disk), compare it with the purchase data of materials and check the income-and-expenditure balance of specific insurance medical materials immediately. The sum of the amount of temporary stock curtailment for the past two years and six months and the annual purchase curtailment amount was 93,380,000 yen.It is concluded that the introduction of the SPD system has contributed much to the improvement of inventory management.
Insurance ; System ; Reduction - action ; Effective ; Original