ABSTRACT
Background/Aims@#Recent studies suggested a favorable effect of indigo naturalis (IN) in inducing remission for refractory ulcerative colitis (UC), however, the maintenance effect of IN for patients with UC remains unknown. Therefore, we conducted a prospective uncontrolled open-label study to analyze the efficacy and safety of IN for patients with UC. @*Methods@#Patients with moderate to severe active UC (clinical activity index [CAI] ≥ 8) took 2 g/day of IN for 52 weeks. CAI at weeks 0, 4, 8, and 52 and Mayo endoscopic subscore (MES) and Geboes score (GS) at weeks 0, 4, and 52 were assessed. Clinical remission (CAI ≤ 4), mucosal healing (MES ≤ 1), and histological healing (GS ≤ 1) rates at each assessment were evaluated. Overall adverse events (AEs) during study period were also evaluated. The impact of IN on mucosal microbial composition was assessed using 16S ribosomal RNA gene sequences. @*Results@#Thirty-three patients were enrolled. The rates of clinical remission at weeks 4, 8, and 52 were 67%, 76%, and 73%, respectively. The rates of mucosal healing at weeks 4 and 52 were 48% and 70%, respectively. AEs occurred in 17 patients (51.5%) during follow-up. Four patients (12.1%) showed severe AEs, among whom 3 manifested acute colitis. No significant alteration in the mucosal microbial composition was observed with IN treatment. @*Conclusions@#One-year treatment of moderate to severe UC with IN was effective. IN might be a promising therapeutic option for maintaining remission in UC, although the relatively high rate of AEs should be considered.
ABSTRACT
Objective: Lumbar spondylolysis, caused by stress fracture of the pars interarticularis may lead to a bony defect or spondylolisthesis. In adolescents, its surgical treatment employs the smiley face rod method for direct reduction of pseudoarthrotic spondylolysis and spondylolisthesis. Clinical outcomes of this treatment have been occasionally described; however, implant removal has not been discussed previously. We present a patient with lumbar spondylolysis with grade 1 slip at the 5th lumbar vertebra (L5) per the Meyerding classification.Patient: A 14-year-old boy presented with chronic severe lower back pain. Since conservative therapy did not resolve pain or enable resuming sports activities, the smiley face rod repair was performed 7 months after the initial treatment.Result: Anterior slippage of the L5 was surgically reduced. The patient wore a brace for 3 months postoperatively, and partial bone fusion was noted 6 months postoperatively. He resumed his sports activity 8 months postoperatively, and absolute bone fusion was confirmed 18 months postoperatively. Implant removal was performed 3 years postoperatively. Grade 1 slip was corrected with absolute bone fusion, and long-term follow-up revealed good results in terms of healing and rehabilitation.Conclusion: Smiley face rod method that allows for implant removal after bone fusion is suitable for adolescents.
ABSTRACT
Purpose: This study aimed to examine the characteristics of lumbar spondylolysis with acute lumbar spondylolysis on one side and pseudoarthrotic spondylolysis on the other, relative to acute lumbar spondylolysis on one side only.Patients and Methods: Short-tau inversion recovery images obtained through magnetic resonance imaging were used to diagnose 58 patients with acute lumbar spondylolysis with bone marrow edema on one side only. A total of 20 patients who had pars defects on the contralateral side (terminal-stage pseudoarthrotic spondylolysis) were included in the contralateral pseudoarthrosis group (P group). The remaining 38 patients with normal images for the contralateral pars interarticularis were included in the unilateral lesion group, in which the contralateral side was normal (U group). We investigated the union rate, age, sex, lesion laterality, vertebral level, pathological stage, and existing spina bifida occulta in both groups.Results: The P group was characterized by a higher proportion of right-side cases, L5 lesions, more progressed pathological stage, and spina bifida occulta and a significantly lower union rate than the U group.Conclusion: The union rate in patients with lumbar spondylolysis with acute lumbar spondylolysis on one side and pseudoarthrotic spondylolysis on the opposite side was only 15%. We should inform patients with acute unilateral spondylolysis lesions and contralateral pseudoarthrosis about this poor union rate and urge them to choose their therapy accordingly.
ABSTRACT
BACKGROUND/AIMS: It remains uncertain which patients with stricturing-type Crohn's disease (CD) require early small bowel surgery after the initial diagnosis. We aimed to clarify clinical characteristics associated with the intervention in such condition of CD. METHODS: We retrospectively evaluated the clinical course of 53 patients with CD and small bowel strictures who were initially treated with medications after the initial diagnosis. We investigated possible associations between small bowel surgery and the following: clinical factors and radiologic findings at initial diagnosis and the types of medications administered during follow-up. RESULTS: Twenty-eight patients (53%) required small bowel resection during a median follow-up period of 5.0 years (range, 0.5–14.3 years). The cumulative incidence rates of small bowel surgery at 2, 5, and 10 years were 26.4%, 41.0%, and 63.2%, respectively. Univariate analysis indicated that obstructive symptoms (P=0.036), long-segment stricture (P<0.0001), and prestenotic dilation (P<0.0001) on radiography were associated with small bowel surgery, and immunomodulatory (P=0.037) and biological therapy (P=0.008) were significant factors during follow-up. Multivariate analysis revealed that long-segment stricture (hazard ratio [HR], 4.25; 95% confidence interval [CI], 1.78–10.53; P=0.001) and prestenotic dilation (HR, 3.41; 95% CI, 1.24–9.62; P=0.018) on radiography showed a positive correlation with small bowel surgery, and biological therapy (HR, 0.40; 95% CI, 0.15–0.99; P=0.048) showed a negative correlation. CONCLUSIONS: CD patients with long-segment stricture and prestenotic dilation on radiography seem to be at a higher risk of needing small bowel surgery. For such patients, early surgical intervention might be appropriate, even at initial diagnosis.
Subject(s)
Humans , Biological Therapy , Constriction, Pathologic , Crohn Disease , Diagnosis , Follow-Up Studies , Incidence , Intestine, Small , Multivariate Analysis , Radiography , Retrospective StudiesABSTRACT
BACKGROUND/AIMS: Gastrointestinal stromal tumor (GIST) is one of the most common types of submucosal tumors (SMTs). Because of GIST's malignant potential, it is crucial to differentiate it from other SMTs. The present study aimed to identify characteristic endoscopic findings of GISTs in the small intestine. METHODS: We reviewed the clinicopathological and endoscopic findings of 38 patients with endoscopically or surgically resected SMTs in the small intestine. SMTs were classified into GIST and non-GIST groups, and clinicopathological and endoscopic findings were compared between the 2 groups. RESULTS: Fifteen patients had GIST and 23 patients had other types of SMTs in the small intestine. Comparison of the endoscopic findings between the 2 groups revealed that dilated vessels in the surrounding mucosa were significantly more in number in the GIST group than in the non-GIST group (P<0.05). However, there were no other differences in endoscopic findings between the 2 groups. Among patients with GISTs, the presence of dilated vessels in the surrounding mucosa was not associated with bleeding risk, tumor size, or metastasis rate at diagnosis. CONCLUSIONS: Dilated vessels in the surrounding mucosa, identified during balloon-assisted endoscopy, may be a diagnostic indicator for GIST in the small intestine. However, its clinical significance should be further analyzed.
Subject(s)
Humans , Diagnosis , Endoscopy , Gastrointestinal Stromal Tumors , Hemorrhage , Intestine, Small , Mucous Membrane , Neoplasm MetastasisABSTRACT
Objective: Spontaneous spinal epidural hematoma is rare and therefore difficult to diagnose. This study evaluated the clinical features of this condition in patients admitted to our hospital.Patients and Methods: We evaluated 12 patients with spontaneous spinal epidural hematoma who were treated at our hospital. We investigated the following variables in these patients: underlying diseases, medications used, initial symptoms, spinal level affected, whether transported to the hospital by ambulance, department where first evaluated, mass lesion on computed tomography with soft tissue window settings, time interval between symptom onset and diagnosis, treatment received, and Frankel classification on arrival and when last observed.Results: Five patients reported the use of antiplatelet or anticoagulant drugs. All patients in this study reported acute onset of severe pain as the initial symptom, and 10 patients reported some degree of paralysis accompanying the pain. With respect to the morbidity level, the cervical region was the most common site of involvement (n=7). Ten patients were transported to the hospital at night via ambulance. Five patients first visited the Department of Internal Medicine. Seven patients presented with a mass lesion on computed tomography with soft tissue window settings. The time interval between symptom onset and diagnosis ranged from 2 hours to 6 days. Three and 9 patients received conservative and surgical treatments, respectively. No patient showed worsening of Frankel classification.Conclusion: Acute onset of severe pain was the most characteristic clinical symptom. Spontaneous spinal epidural hematoma should be included in the differential diagnosis. Computed tomography with soft tissue window settings may rule out cerebrovascular disease and cardiovascular disease, and specifically detect a hematoma. Subsequent magnetic resonance imaging can diagnose a spontaneous spinal epidural hematoma at an early stage.
ABSTRACT
Objective: As a minimal invasive surgery for the treatment of thumb carpometacarpal joint (trapeziometacarpal [TMC]) arthritis, we performed an arthroscopic synovectomy for Eaton stage II to IV arthritis.Patients and Methods: We included patients who were effectively treated with a corticosteroid injection, experienced recurrence of TMC pain, and had no major instability of the TMC. Surgery was performed in 17 female patients. Synovectomy was performed, when possible, using radiofrequency and a shaver. The mean follow-up period was 27.2 months.Results: Two patients required additional surgery; however, 15 patients were satisfied with the outcome. The mean visual analogue scale score improved from 8.8 preoperatively to 2.2 postoperatively.Conclusion: Arthroscopic synovectomy is indicated to be an effective treatment for stage II to IV TMC arthritis. The goal of this treatment was to relieve severe pain minimally invasively. Furthermore, if symptoms remain or reoccur, another curative procedure can be chosen.
ABSTRACT
Knee swelling after total knee arthroplasty (TKA) is common and can lead to loss of functional performance. The aim of this study was to reveal the factors related to knee swelling after TKA. In total, 86 patients who underwent unilateral TKA were enrolled. Changes in thigh circumference at 0, 5, and 10 cm proximal from upper pole of the patella were evaluated. In addition, age, body mass index, operation time, blood loss volume, C-reactive protein, albumin, and D-dimer levels, and changes in knee flexion were also assessed preoperatively and at 7 days postoperatively. Thigh circumference at all sites increased postoperatively. Changes in thigh circumference at the superior edge of the patella correlated with changes in knee flexion (r =－0.33, p < 0.01). No significant correlation was found between the other factors. In conclusion, this study revealed a correlation between swelling and flexion after TKA, but no correlation between other factors pre-, intra-, or postoperatively. It is thus necessary to consider other factors in the future.
ABSTRACT
Objective: The aim of this study was to determine the prevalence of curable and pseudoarthrosis stages of adolescent lumbar spondylolysis under high school students complaining of and seeking medical consultation for low back pain.Patients and Methods: We analyzed age, sex, morbidity, presence of spina bifida occulta (SBO), and competitive sport discipline of patients with lumbar spondylolysis. We then stratified their pathological stage using a modified classification system via magnetic resonance imaging and computed tomography.Results: Of 507 patients, 451 lesions in 268 patients were diagnosed with lumbar spondylolysis (average age, 14.7 years; sex ratio, 215:53 male/female). Morbidity levels were as follows: L1, 1 lesion in 1 patient; L2, 9 lesions in 5 patients; L3, 38 lesions in 25 patients; L4, 106 lesions in 74 patients; L5, 297 lesions in 189 patients, and SBO verified in 111 patients. A total of 264 patients played a specific sport: baseball, 93; soccer, 49; volleyball, 21; track and field, 21; basketball, 20; others, 164. The prevalence of curable- and pseudoarthrosis-stage lumbar spondylolysis was 206 lesions in 142 patients, and 141 lesions in 87 patients, respectively.Conclusion: With 59.3% of patients having curable-stage lumbar spondylolysis, adolescent athletes with low back pain are urged to seek consultation. Furthermore, clinicians should perform magnetic resonance imaging to avoid misdiagnosis.
ABSTRACT
Clinical research is essential for the practice of evidence-based medicine. This study reports on our current practice of clinical research support in Mito Kyodo General Hospital and discusses future challenges. In April 2013, the University of Tsukuba hired a clinical research assistant to provide clinical research support in Mito Kyodo General Hospital. The clinical research assistant worked full-time in the hospital in collaboration with 3 university faculty members. The target population for this study comprised 450 medical personnel including doctors, nurses, and other medical staff. From April 2014, 1 of the 3 faculty members visited the hospital once a month to offer clinical research consultations and deliver a lecture on nursing research. We analyzed past records of clinical research support and conducted a questionnaire survey to explore the level of satisfaction of the medical personnel. Four-hundred and ninety records of 91 research topics proposed by 68 medical personnel were identified. Of these, 93.4% were proposed by doctors or nurses. Most studies employed an observational study design (64.8%) and were conducted in order to make a presentation at an academic conference (51.1%). The consultation sessions were held 1–5 times, for 40–405 min, and lasted from 1–84 days per research topic. Consultations mostly pertained to research design and protocol planning (57.1%). Forty-seven clients were invited to participate in the questionnaire survey, 30 of whom provided valid responses. The results showed that 96.6% of the clients were satisfied with the consultations. The number of clients who participated in the consultations comprised only 15.1% of the target population. These practice biases need to be addressed in future. However, nearly all respondents were satisfied with the consultations. These findings suggest that our clinical research support was beneficial to medical personnel.
ABSTRACT
Complex regional pain syndrome (CRPS) is a disease characterized especially by pain, swelling, limited range of motion (ROM), vasomotor instability, and atrophy of bones in the extremities. In rehabilitation, it is important to suppress excessive sympathetic activity and break the vicious cycle of pain. This is achieved with mild ROM exercise and a mental approach. In this case, the patient had severe pain, swelling, redness, and excessive sweating of the right hand. With alternating warm and cold bath therapy, his symptoms were gradually alleviated. Alternating warm and cold bath therapy may help in the treatment of CRPS.
ABSTRACT
Europe has a long history with its own traditional medicines. In Germany, the practice of traditional European and Asian medicine along with modern medicine is called Integrative Medicine. The pain clinics at Munich University, TCM Klinik Bad Kotzting, Immanuel Klankenhaus and Zen Haus Klinik are well-known centers of Integrative Medicine in Germany. We visited these hospitals and clinics and report on the state of their treatment.<BR>Four-week programs in chronic pain, traditional Chinese medicine, natural therapy, and traditional Japanese medicine with aromatherapy are given at these facilities. Moreover, Complementary and Alternative medicines are widely covered by public or private insurance. And one reason for the spread of Integrative Medicine may be these social conditions, in addition to historical background.
ABSTRACT
The Great East Japan earthquake and tsunami disaster that occurred on March 11, 2011 seriously destroyed Japanese social activities the medical system included. We provided medical support to the damaged area, and mainly performed Oriental medicine. Traditional methods using physical diagnoses and the treatments with herbs, acupuncture, and massage were effective, where any infrastructure had suffered or any modern medical facilities had been destroyed. Acute phase infectious disease, common colds, and hypothermia were dominant. Allergies increased two weeks later, and there was much mental distress, and chronic pain symptoms one month later. We prescribed Kampo herbal medicines for common colds, hypothermia, allergies, and mental distress. Moreover, we also performed acupuncture and kneaded patients' body to reduce pain, stiffness, and edema. These treatments were effective for both physical and mental distress. Thus we believe that Oriental medicine is valuable in disaster situations.
ABSTRACT
The purpose of this study was to clarify the differences in reaction time, stepping frequency and stepping endurance estimated by chronological age compared to skeletal age. The participants were 76 well-trained soccer players aged from 9.7 to 14.8 years old. Height and weight were measured before training. Their skeletal ages were evaluated by RUS score of TW II method. RUS score was calculated for skeletal age by Murata's method. Reaction time, stepping frequency and endurance were measured by Talent-Diagnose-System (Werthner Sports Consulting, KEG, Co, Ltd.) . For chronological age, height increased linearly from 9 to 14. Height estimated by skeletal age increased slowly from 8 to 10, then increased drastically between the ages of 10 to 15. Significant change was shown between the ages of 12 and 13 (p<0.01) . Complex reaction time (CRT) estimated from chronological age developed linearly from 9 to 14 years of age. However for skeletal age, CRT at 10 was slower than at 8 and 9 years of age. Then it developed significantly between the ages of 10 and 11 (p<0.05) . On the other hand, stepping frequency and endurance did not show as remarkable a change with increasing age as reaction time. The results of this present study indicate that in adolescent soccer players, there are some differences between skeletal age and chronological age in cross-sectional change of reaction time. Moreover, skeletal age did not affect the development of stepping frequency and endurance.