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1.
J Multidiscip Healthc ; 16: 2937-2945, 2023.
Article in English | MEDLINE | ID: mdl-37795380

ABSTRACT

Background: Our facility's dental team consists of a full-time dentists and dental hygienists who work exclusively in the wards to implement best practices in oral healthcare. We executed the dental care system (DCS) that includes lectures and practical training for nurses conducted by dentists and dental hygienists, the introduction to oral assessment, standardization of oral care procedures, a process for nurses to request the dental team, and early bedside oral screening conducted by the dental team. This study investigated the DCS's effects on the incidence of stroke-associated pneumonia (SAP). Methods: This single-center retrospective cohort study included 2,771 acute stroke patients who were newly hospitalized between April 1, 2012, and March 31, 2020. The 8-year period was divided into four phases at two-year intervals as follows: Pre (N=632), Post-1 (N=642), Post-2 (N=716), and Post-3 (N=781). Pre was prior to DCS practice. Post-1 was an early introduction to DCS. Post-2 simplified dental team requests from nurses, and Post-3 added bedside oral screening within 72 hours of admission by the dental team. Statistical analysis was performed using the Cochran-Armitage trend test, followed by multivariate logistic regression. Results: A decrease in SAP rates was observed across the four groups (P<0.0001). Logistic regression analysis revealed a significant difference for respiratory disease (odds ratio 7.74, 95% confidence interval 5.49-10.90), hypertension (2.28, 1.39-3.73), cardiac failure (1.72, 1.04-2.85), and diabetes (1.59, 1.11-2.26), 3-digit code on the Japan coma scale (3.57, 2.53-5.05 [reference ≤2-digit code]), age ≥90 years (2.34, 1.15-4.77 [reference 18-59 years]), male (1.86, 1.31-2.67), and the Post-1 (0.49, 0.31-0.76 [reference Pre]), Post-2 (0.38, 0.25-0.61 [reference Pre]), and Post-3 (0.24, 0.15-0.40 [reference Pre]) periods. Conclusion: The suppression of SAP is effectively achieved through early intervention and education of nurses by dental professionals.

2.
BMC Nephrol ; 23(1): 314, 2022 09 19.
Article in English | MEDLINE | ID: mdl-36123635

ABSTRACT

BACKGROUND: Cholesterol crystal embolization syndrome (CES) occurs when an atherosclerotic plaque causes small-vessel embolization, resulting in multi-organ damage. Although CES is pathologically characterized by an infiltration of eosinophils, the implication of the systemic inflammatory response represented by hypereosinophilia is unclear in clinical practice. Herein we present the case of a patient diagnosed with CES who developed multiple allergic organ injuries, including daptomycin-related dermatitis and later vancomycin-induced acute tubulointerstitial nephritis, which was successfully treated by the withdrawal of each medicine with or without corticosteroid therapy, one by one. CASE PRESENTATION: A 76-year-old Japanese man diagnosed with thoracic aneurysm rupture underwent total arch replacement through the open stent graft technique. Postoperatively, he developed methicillin-resistant Staphylococcus epidermidis bacteremia, which was treated with daptomycin. Subsequently, he presented with palpable purpura on both dorsal feet, erythema around his body, and hypereosinophilia. Daptomycin was replaced with vancomycin due to suspicion of drug-induced erythema. The erythema gradually faded. On nine days after vancomycin therapy, the systemic erythema rapidly reappeared followed by acute renal failure. The renal function decline prompted hemodialysis. A skin biopsy revealed cholesterol embolization, whereas a kidney biopsy revealed acute tubulointerstitial nephritis. After vancomycin discontinuation and initiation of systemic corticosteroid treatment, his kidney function was restored to the baseline level. CONCLUSIONS: The present case highlights cholesterol embolization can cause allergic complications in addition to direct organ damage.


Subject(s)
Daptomycin , Embolism, Cholesterol , Methicillin-Resistant Staphylococcus aureus , Aged , Cholesterol , Embolism, Cholesterol/complications , Embolism, Cholesterol/diagnosis , Humans , Immunity , Male , Nephritis, Interstitial , Vancomycin/therapeutic use
3.
Int J Dent ; 2022: 6193818, 2022.
Article in English | MEDLINE | ID: mdl-35910086

ABSTRACT

Background: A full-time dentist was assigned to a ward at our hospital to improve the quality of oral healthcare for hospitalized patients. A dental care system (DCS) was created to facilitate the collaboration between the full-time dentist and the nursing department. Objective: To investigate the effects of DCS implementation on the incidence of pneumonia in patients with acute stroke. Methods: This retrospective cohort study comprised 945 hospitalized acute stroke patients categorized into three groups: pre-, during-, and post-DCS. The DCS comprised dentist-led lectures and practical sessions, oral assessments, standardized oral care techniques, and information on the procedures for nurse-requested dental intervention. Data were extracted from the Japanese Diagnosis Procedure Combination database and medical records. The attributes of the patients, incidence of pneumonia, and number of patients who requested dental intervention were determined. Results: The odds ratios of pneumonia onset were 3.16 (95% confidence interval [CI], 1.65-6.05; P = 0.001) in the pre-DCS and 2.80 (95% CI, 1.48-5.31; P = 0.002) in the during-DCS group compared with the post-DCS group, thereby confirming the effect of DCS on the incidence of pneumonia. The number of dental requests in the post-DCS group was noted to be higher than that in the pre-DCS group (P = 0.002). Conclusion: Oral management by a full-time dentist was found to be effective in reducing the incidence of pneumonia in patients with acute stroke. To implement the best oral care practices in the hospital wards, the full-time dentist should work as a member of the medical team.

4.
Radiol Case Rep ; 15(3): 246-249, 2020 Mar.
Article in English | MEDLINE | ID: mdl-31956381

ABSTRACT

Four-dimensional computed tomography has been used to evaluate moving structures and is a useful method to diagnose cardiovascular diseases. We report a case of cerebral infarction due to the thrombus in the ascending aorta, and utilized 4-dimensional computed tomography angiography for visualizing the movement of the thrombus, which prompted early surgical intervention to prevent further thromboembolism. Although transesophageal echocardiography is an established method to evaluate the ascending aorta, it has some contraindications and complications. Four-dimensional computed tomography angiography is an excellent alternative without blind spots to evaluate the ascending aorta more quickly than transesophageal echocardiography.

5.
J Renin Angiotensin Aldosterone Syst ; 20(1): 1470320319834409, 2019.
Article in English | MEDLINE | ID: mdl-30843458

ABSTRACT

INTRODUCTION:: Angiotensin-converting enzyme (ACE) inhibitors are one of the most commonly used medications for hypertension. Rarely, ACE inhibitors have the potential to cause a syndrome of inappropriate secretion of antidiuretic hormone (SIADH). CASE PRESENTATION:: A 70-year-old woman with > 10 years ACE inhibitor therapy with normonatremia suddenly developed severe SIADH when she took a liquid diet in the uneventful perioperative period, with hemodynamic stability and no surgical complications. She promptly recovered from SIADH subsequent to discontinuing the ACE inhibitor therapy and changing her diet. Therefore, it was assumed that excess antidiuretic hormone secretion due to an ACE inhibitor and free water load from the liquid diet contributed to hyponatremia in our patient. CONCLUSION:: Patients treated with an ACE inhibitor can latently experience inappropriate secretion of antidiuretic hormone, and rapidly develop severe hyponatremia together with additional factors affecting water or salt homeostasis regardless of the length of the administration duration. Clinicians should monitor serum sodium levels in such patients not only just after the initiation of ACE inhibitors but also upon the appearance of those factors.


Subject(s)
Angiotensin-Converting Enzyme Inhibitors/adverse effects , Inappropriate ADH Syndrome/chemically induced , Inappropriate ADH Syndrome/surgery , Perioperative Period , Aged , Disease Progression , Female , Humans
6.
Intern Med ; 57(20): 3035-3040, 2018 Oct 15.
Article in English | MEDLINE | ID: mdl-29877285

ABSTRACT

We report the findings of an 18-year-old boy with immunoglobulin A vasculitis (IgAV) complicated with bowel perforation and nephritis. He presented with abdominal pain, arthralgia and palpable purpura. Massive proteinuria developed during his clinical course. The patient was treated successfully using combination therapy of glucocorticoid (GC), cyclosporine (CYA) and factor XIII (F XIII) replacement. A standard treatment strategy for severe IgAV patients has not been established due to its rarity. Combination therapy using GC, CYA and F XIII replacement should be considered for severe IgAV patients.


Subject(s)
Cyclosporine/therapeutic use , Factor XIII/therapeutic use , Glomerulonephritis, Membranoproliferative/drug therapy , Glucocorticoids/therapeutic use , Intestinal Perforation/drug therapy , Vasculitis/complications , Vasculitis/drug therapy , Adolescent , Combined Modality Therapy , Glomerulonephritis, Membranoproliferative/etiology , Humans , Immunoglobulin A/blood , Intestinal Perforation/etiology , Male , Treatment Outcome
7.
Clin Exp Nephrol ; 20(3): 425-32, 2016 Jun.
Article in English | MEDLINE | ID: mdl-26415960

ABSTRACT

BACKGROUND: In patients with IgA nephropathy (IgAN), recurrence after steroid pulse therapy is associated with reduced renal survival. However, the predictors of recurrence have not yet been clarified. METHODS: All patients who received 6-month steroid pulse therapy from 2004 to 2010 in our four affiliated hospitals and achieved a reduction of proteinuria to <0.4 g/day 1 year after treatment were retrospectively evaluated. The primary outcome was proteinuria ≥1.0 g/day during follow-up or additional antiproteinuric therapy. Two histological classifications were evaluated, the Oxford Classification with a split system and Japanese histological grades (HGs) with a lumped system. RESULTS: During a median follow-up of 3.4 years, 27 (26.7 %) of the 101 patients showed recurrence. Multivariate analysis showed that HG was the only significant predictor of recurrence, with HG 2+3+4 vs HG 1 having a hazard ratio of 7.38 (95 % confidence interval 1.52-133). Furthermore, in patients with mesangial hypercellularity according to the Oxford Classification, cumulative rate of recurrence-free survival was greater in patients with steroid therapy plus tonsillectomy compared with those who received steroid therapy alone (Log-rank test, P = 0.022). However, this association was not observed in patients without mesangial hypercellularity. CONCLUSIONS: HG is a novel predictor of recurrence after steroid pulse therapy in patients with IgAN. Moreover, the combination of steroid pulse therapy plus tonsillectomy may indicate a lower risk of recurrence in patients with mesangial hypercellularity, as defined by the Oxford Classification.


Subject(s)
Cell Proliferation , Glomerular Mesangium/pathology , Glomerulonephritis, IGA/surgery , Tonsillectomy , Adult , Biopsy , Combined Modality Therapy , Disease-Free Survival , Female , Glomerulonephritis, IGA/classification , Glomerulonephritis, IGA/drug therapy , Glomerulonephritis, IGA/pathology , Humans , Japan , Kaplan-Meier Estimate , Male , Proteinuria/diagnosis , Proteinuria/drug therapy , Proteinuria/surgery , Pulse Therapy, Drug , Recurrence , Retrospective Studies , Risk Factors , Steroids/administration & dosage , Time Factors , Treatment Outcome
8.
Am J Case Rep ; 16: 357-60, 2015 Jun 09.
Article in English | MEDLINE | ID: mdl-26057570

ABSTRACT

BACKGROUND: Autoimmune optic neuropathy is optic neuropathy caused by an autoimmune mechanism. As treatment, steroid is usually used. If steroid is ineffective to improve visual function, other immunosuppressive agents are used as needed. Rituximab is one of molecular target agents and is now used as treatment for several types of autoimmune disorders. CASE REPORT: A 77-year-old woman presented with vision loss in her left eye. Her past medical history included disturbances of multiple organs. Laboratory tests revealed positive myeloperoxidase-anti-neutrophil cytoplasmic antibody. We assumed that her vision loss was caused by autoimmune optic neuropathy and put her on high-dose glucocorticoid therapy. Her visual function quickly re-deteriorated after high-dose glucocorticoid therapy discontinuation. To achieve vision improvement, we added rituximab to her treatment regimen. Her visual acuity recovered to almost 20/20 within a week later. She received other 3 rituximab-infusions and her visual acuity remained 20/20 while tapering glucocorticoid. CONCLUSIONS: Autoimmune optic neuropathy may result in blindness if treatment fails. Rituximab may be a therapeutic option for autoimmune optic neuropathy and may produce immediate response.


Subject(s)
Autoimmune Diseases/drug therapy , Glucocorticoids/therapeutic use , Optic Nerve Diseases/drug therapy , Rituximab/therapeutic use , Aged , Autoimmune Diseases/diagnosis , Autoimmune Diseases/immunology , Drug Therapy, Combination , Female , Humans , Immunologic Factors/therapeutic use , Optic Nerve Diseases/diagnosis , Optic Nerve Diseases/immunology , Tomography, X-Ray Computed , Visual Acuity
9.
Rinsho Shinkeigaku ; 47(2-3): 73-8, 2007.
Article in Japanese | MEDLINE | ID: mdl-17511272

ABSTRACT

We report a 66-year-old man with spreading lesion over the bilateral splenia of the corpus callosum shown on MRI. On admission, unknown fever and myoclonus-like involuntary movement in the left forefinger and middle finger were observed. There were no remarkably abnormal data in the serum, the cerebrospinal fluid and electroencephalogram. However, T2-weighted MRI revealed the high signal spreading over the bilateral splenia of the corpus callosum, while enhanced effects were not observed by Gd contrast on T1-weighted MRI. Diffusion and FLAIR MRI also showed the high signals limited to the same part of the splenia bilaterally as on T2-weighted MRI, discriminating it from other lacunar lesions and old cerebral infarctions. Neurological features, which were considered to be directly associated with the fresh lesion, were impairment of verbal and visual memories. Near the time the therapies including high-dose steroid were given, the consciousness of the patient worsened rapidly on a day-to-day basis and disseminated intravascular coagulation syndrome (DIC) also occurred. By administering low-molecule heparin, consciousness disturbance and involuntary movements recovered completely. Following the improved symptoms, FLAIR MRI showed a reduced level of the signal seven months after the onset. A demyelinating disease over the bilateral splenia of the corpus callosum should be considered as the final diagnosis. Follow-up of the changes in this case is expected to provide a more accurate diagnosis.


Subject(s)
Consciousness Disorders/etiology , Corpus Callosum/pathology , Encephalomyelitis, Acute Disseminated/etiology , Encephalomyelitis, Acute Disseminated/pathology , Fever/complications , Magnetic Resonance Imaging , Aged , Atrophy , Communicable Diseases/complications , Consciousness Disorders/therapy , Disseminated Intravascular Coagulation/etiology , Disseminated Intravascular Coagulation/therapy , Encephalomyelitis, Acute Disseminated/therapy , Humans , Male , Myoclonus/etiology , Myoclonus/therapy , Prognosis
10.
Rinsho Ketsueki ; 47(6): 521-5, 2006 Jun.
Article in Japanese | MEDLINE | ID: mdl-16862980

ABSTRACT

A 68-year-old woman suffering from a left iliac tumor and severe back pain was admitted to another hospital in May 1999. The bone X-ray, CT scan and MRI demonstrated a 7 cm x 5 cm left iliac tumor with osteolysis and she was transferred to our hospital. Angiography demonstrated multiple hypervascular lesions in the left ilium, lumbar vertebrae, left ischium, left pubis and left rib. The tumor was resected and diagnosed as a plasmacytoma. Immunoelectrophoresis did not show any M-protein in the serum and urine, but the patient was diagnosed as having a non-secretory or low producing multiple myeloma because of the presence of 42.8% of abnormal plasma cells in the bone marrow aspirate. Her symptoms improved following 3 courses of MCNU-VMP therapy and the bone marrow plasma cells decreased to less than 5%. She was discharged and treated as an outpatient but relapsed and died of chemotherapy-resistant myeloma. We report this case because macro-angiogenesis in a multiple myeloma demonstrated by angiography is rare and interesting.


Subject(s)
Multiple Myeloma/diagnostic imaging , Neovascularization, Pathologic/diagnostic imaging , Plasmacytoma/diagnostic imaging , Aged , Angiography , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone and Bones/blood supply , Bone and Bones/diagnostic imaging , Drug Administration Schedule , Female , Humans , Melphalan/administration & dosage , Multiple Myeloma/drug therapy , Nitrosourea Compounds/administration & dosage , Plasmacytoma/blood supply , Plasmacytoma/drug therapy , Prednisolone/administration & dosage , Prednisone/administration & dosage , Tomography, X-Ray Computed , Vindesine/administration & dosage
11.
Rinsho Shinkeigaku ; 44(6): 372-4, 2004 Jun.
Article in Japanese | MEDLINE | ID: mdl-15293762

ABSTRACT

A 40-year-old man was admitted to our hospital because of consciousness disturbance, dysarthria and numbness in his right hand. Computed tomography of the head showed a cerebral hemorrhage of the left putamen. The patient was judged to have an indication of operation, and frontal craniotomy to evacuate hematoma was performed. During the operation, massive whitish pus flowed out at the time of surgery. Therefore, hemorrhage into a brain abscess was diagnosed. We reported this unique and interesting case whose brain abscess could not be differentiated from an ordinary hypertensive putaminal hemorrhage based on clinical findings and CT image. This diagnosis was not made until the patient was operated on through a craniotomy.


Subject(s)
Brain Abscess/diagnosis , Craniotomy , Putaminal Hemorrhage/surgery , Adult , Brain Abscess/etiology , Humans , Male , Putaminal Hemorrhage/complications , Putaminal Hemorrhage/diagnostic imaging , Tomography, X-Ray Computed
12.
Rinsho Shinkeigaku ; 43(8): 470-6, 2003 Aug.
Article in Japanese | MEDLINE | ID: mdl-14658398

ABSTRACT

A previously healthy 30-year-old woman was admitted to our hospital because of impaired consciousness after convulsion. A temporary diagnosis of herpes simplex encephalitis was made, and intravenous acyclovir (ACV) therapy (250 mg four times daily in normal saline over 2 hours) was started. Three days later, she became confused, and was having hallucinations, dysarthria and generalized painful seizures occurred without focal neurologic deficit. Whether the neuropsychiatric symptoms were related to herpes simplex encephalitis or acyclovir neurotoxity was initially unclear. The brain MRI and lumbar puncture findings were initially normal, but abnormal FLAIR lesions appeared later. ACV-associated encephalopathy was considered. ACV was discontinued, and she recovered from the neurological disorder within 24 hours. Although blood levels of acyclovir were not determined, it is unlikely that they were in a toxic range, in view of her normal renal function.


Subject(s)
Acyclovir/adverse effects , Antiviral Agents/adverse effects , Brain Diseases/chemically induced , Brain Diseases/psychology , Encephalitis, Viral/drug therapy , Acute Disease , Adult , Brain Diseases/diagnosis , Dysarthria/chemically induced , Epilepsy, Generalized/chemically induced , Female , Hallucinations/chemically induced , Humans , Kidney Diseases , Magnetic Resonance Imaging
13.
Acta Haematol ; 108(1): 47-52, 2002.
Article in English | MEDLINE | ID: mdl-12145468

ABSTRACT

We describe a 69-year-old Japanese male with acute leukemia with a CD7+ and CD56+ immunophenotype presenting with multiple lymphadenopathy. He was treated with idarubicin and cytosine arabinoside. Although the leukemia showed partial response, the patient did not achieve complete remission. He died of sepsis due to severe neutropenia after the third course of chemotherapy. His autopsy revealed blast infiltration in the lymph nodes, liver, spleen and vertebral bone marrow. Recently, CD7+ and CD56+ myeloid/natural killer precursor acute leukemia has been associated with a poor prognosis. Our case illustrates that myeloid/natural killer cell precursor acute leukemia shows some response to intensive chemotherapy for acute myeloid leukemia, but such therapy is insufficient to effect a cure. To overcome the resistance of this disease to chemotherapy, further studies should explore other treatment strategies.


Subject(s)
Antigens, CD7/analysis , Antigens, Neoplasm/analysis , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , CD56 Antigen/analysis , Cytarabine/analogs & derivatives , Killer Cells, Natural/pathology , Leukemia, Myeloid/drug therapy , Myeloid Cells/pathology , Neoplastic Stem Cells/pathology , Acute Disease , Aged , Antigens, CD/analysis , Antigens, Differentiation, Myelomonocytic/analysis , Cytarabine/administration & dosage , Daunorubicin/administration & dosage , Diagnosis, Differential , Etoposide/administration & dosage , Fatal Outcome , Humans , Idarubicin/administration & dosage , Killer Cells, Natural/chemistry , Leukemia, Myeloid/diagnosis , Leukemia, Myeloid/pathology , Leukemic Infiltration , Lymphoma, Non-Hodgkin/diagnosis , Male , Mercaptopurine/administration & dosage , Mitoxantrone/administration & dosage , Myeloid Cells/chemistry , Neoplastic Stem Cells/chemistry , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis , Sarcoma, Myeloid/diagnosis , Sialic Acid Binding Ig-like Lectin 3
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