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Objective: To investigate the feasibility of peripheral sensory nerve stimulation combined with task-oriented training in patients with stroke during inpatient rehabilitation. Design: A pilot randomized crossover trial. Setting: Two rehabilitation hospitals. Subjects: Twenty-two patients with subacute stroke. Interventions: Participants were randomly assigned to two groups and underwent two weeks of training in addition to conventional inpatient rehabilitation. The immediate group underwent peripheral sensory nerve stimulation combined with task-oriented training in the first week, followed by another week with task-oriented training alone. The delayed group underwent the same training in reverse order. Main measures: Outcome measures were the level of fatigue and Wolf Motor Function Test. Patients were assessed at baseline, one and two weeks. Results: All participants completed the study with no adverse events. There was no significant difference in level of fatigue between each treatment. From baseline to one week, the immediate group showed larger improvements than the delayed groups in the Wolf Motor Function Test (decrease in mean time (± SD) from 41.9 ± 16.2 seconds to 30.6 ± 11.4 seconds versus from 46.8 ± 19.4 seconds to 42.9 ± 14.7 seconds, respectively) but the difference did not reach significance after Bonferroni correction ( P = 0.041). Within-group comparison showed significant improvements in the Wolf Motor Function Test mean time after the peripheral sensory nerve stimulation combined with task-oriented training periods in each group ( P < 0.01). Conclusion: Peripheral sensory nerve stimulation is feasible in clinical settings and may enhance the effects of task-oriented training in patients with subacute stroke.

〔目的〕在宅脳卒中患者に対する運動介入および栄養指導が動脈硬化指数および運動機能に及ぼす影響を調査した。〔対象〕地域在住の脳卒中患者16名。〔方法〕運動は2時間のプログラムを週2回，3ヶ月間実施し，栄養指導は管理栄養士による定期的な食事調査と栄養指導が行われた。評価項目は心臓足関節血管指数（Cardio Ankle Vascular Index: CAVI），足関節上腕血圧比（Ankle Brachial Index: ABI），歩行速度，握力，Functional reach test（FRT），Timed Up and Go test（TUG），30秒立ち上がりテストとした。〔結果〕麻痺側のCAVI値は介入前に比較して有意に低下した。運動機能面ではFRTおよびTUGのみに有意な改善が認められた。〔結語〕今回の結果から運動介入と栄養指導による学際的介入が運動機能面および動脈機能の面からも有効であることが示唆された。

The aim of this study was to examine patients with post-stroke hemiplegia for space estimation disorder during visual reaching for a target. Six patients with post-stroke hemiplegia with no parietal damage were studied, as well as 6 healthy older adults and 6 healthy younger adults as a control group. A target was placed on the table in front of the subject, and then the subject was asked to verbally indicate the farthest reachable point while the target was gradually being moved further away from the subject. The difference was then obtained by measuring the distance from the subject to the indicated point. There was no significant difference in the errors between the estimated and actual values in the healthy older and younger adults. No significant difference was also observed between dominant and non-dominant hands. There were significant differences between the paretic and non-paretic side in the hemiplegic patients, as well as between the paretic side of hemiplegic patients and the dominant hand in the healthy older adults. Compared with healthy subjects, the hemiplegic patients showed a greater difference between the estimated and actual values for both the non-paretic and paretic sides, which indicates an estimation disorder during visual reaching in patients with post-stroke hemiplegia. These results are discussed based on a conversion of the visual coordinates into movement coordinates during visual reaching.

We reviewed 17 patients (15 males and 2 females) who had undergone re-operations for degenerative lumbar disease. They were operated for lumbar disc herniation (LDH) in 12, lumbar spinal canal stenosis (LSCS) in 4, and destructive spondyloarthropathy (DSA) in 1. Among the LDH cases, seven were re-operated for recurrence of LDH, and five for postoperative lumbar spinal stenosis. Their symptoms were due to degenerative changes, and additional herniotomy or laminectomy was done with good results. One was combined with root injury during operation. Re-operation proved insufficient for scar formation. In LSCS cases, recurrence of symptoms was due to insufficient decompression as a result of a too narrow laminotomy in the transverse or caudocranial direction. Additional laminectomy and lumbar fusion provided good results. In the DSA case, one of the reasons for incomplete union was insufficient range of spinal fusion. Additional lumbar fusion provided good results.

To assess the efficacy of cancer chemotherapy, an important index is apoptosis of the target cells, which can usually be confirmed by electron microscopy (EM). We established a new experimental technique, whereby cancer cells (MKN45) were distributed in thin collagen gel as one or two cell layers, and cultured with anti‐cancer drugs (5‐FU and CDDP). The cells were stained with fluorescent Hoechst 33258 (Ho) and photographed, then with hematoxylin and eosin (H&E) and again photographed, and processed for EM. This approach allowed us to characterize the patterns of death of single cells in detail. There were six patterns of cell damage: two patterns of apoptosis, early peripheral condensation of chromatin and late apoptotic bodies, two patterns of necrosis, cytoplasmic swelling and washed‐out images, and two further patterns, with morphological features of both apoptosis and necrosis, neither classified into necrosis nor apoptosis. The results show that cell death patterns can be mostly determined by combining observations of Ho and H&E‐stained cells without the necessity for EM observation.

Disease-related changes in prostaglandin (PG) levels may contribute to a bleeding tendency and local vasodilation in the portal circulation in patients with liver cirrhosis. We measured the plasma and tissue PG metabolite levels (6-keto PGF1α and thromboxane TXB2) in the systemic and portal circulation in 12 rats with CCl4-induced liver cirrhosis (LC rats) and ten with portal hypertension induced by 2 weeks of partial portal ligation (PH rats) and compared them with normal control rats (n=10). We also compared the plasma PG metabolite levels in the systemic and portal circulations in 11 cirrhotic patients with hepatocellular carcinoma (HCC) and five patient controls without liver disease. In the animal study, LC rats had significantly higher portal blood 6-keto PGF1α (P

Assessing abdominal complications in patients who have previously suffered high spinal cord injury is very difficult because the resultant loss of sensory, motor, and reflux function of the abdominal wall can mask the typical signs of acute abdomen such as tenderness, muscle rigidity, and peritoneal rebound pain. We recently diagnosed a small intestinal perforation in a 77-year-old man with a C6-7 spinal cord injury sustained 14 years earlier. The patient was correctly diagnosed as having an acute abdominal condition, despite palsy of abdominal wall sensation. An emergency laparotomy was done and a 40-cm length of affected ileum, about 180 cm distal to the Treitz ligament, including a 1-cm perforation, was resected, followed by an end-to-end anastomosis. We report this case to raise awareness of the need for appropriate diagnosis and early surgical treatment of abdominal complications in spinal-cord-injured patients.

Chronic pain emerges not only because of the injury of peripheral organs or a plastic change in spinal nerves, but also because of plasticity in the brain [1]. Therefore, the development of interventions dedicated to the rehabilitation of pain must occur via approaches that cause changes in the brain, instead of approaches that treat only peripheral organs. In particular, pain is composed of three facets, including a sensory aspect, a cognitive aspect, and an emotional aspect [2]. Thus, the rehabilitation of the brain represents an approach to that will address the cognitive and emotional aspects in particular.

[Background] The recognition of required treatments for cerebral palsy (CP) patients, including orthopedic surgery, differs according to region. This study was performed to identify factors associated with satisfactory changes in physical function after orthopedic surgery. [Methods] 358 patients were selected for the questionnaire survey. The following information was collected: gender, primary disease, age of initial surgery, total procedural count, operated sites, satisfaction of postoperative rehabilitation frequency, ideal amount of postoperative rehabilitation sessions per week, frequency of voluntary home training per week, satisfaction of the timing of surgery and the current satisfaction with the changes in physical function after the orthopedic surgery. We classified the patients into the satisfied and dissatisfied group according to satisfactory changes in physical function after the surgery. We performed unpaired t-tests and chi-square tests to determine the variables that differed significantly between the groups. Variables with a p value of, 首都大学東京学位論文 副論文

Background: Sensory amplitude electrical stimulation has been reported to induce changes in corticospinal excitability. The aim of this review is to evaluate the effects of sensory electrical stimulation on hand and arm function in stroke patients. Methods: A literature search was undertaken to locate papers that used sensory electrical stimulation in stroke patients. The methodological quality of each study was assessed using the Physiotherapy Evidence Database (PEDro) score. Results: Ten studies were considered suitable for inclusion in this review. Six of the 10 studies provided the PEDro score, with the mean (standard deviation) score being 5.7 (1.0). There were no adverse effects in any of the studies. In only one study, the patients with acute stroke were included. There was much study of patients with mild arm hemiparesis. Most studies reported that sensory electrical stimulation was delivered at 10 Hz with pulse duration of 1 millisecond for 2 hours at the paretic wrist (median and/or ulnar nerve). Five studies reported sensory stimulation should not be used in isolation, but rather in combination with task training, to improve arm and hand function. Conclusions: Sensory electrical stimulation may improve hand and arm function if it combines with functional task training in patients with mild arm paresis but there are no studies with high methodological quality. In addition, it is uncertain whether sensory electrical stimulation would be of benefit for patients with severe paresis and be effective in the acute phase. Therefore, the results of this review remain inconclusive due to a lack of suitable randomized controlled trials.

肝硬変(LC)では動脈硬化の進展が他疾患に比し少ないとされている.当教室の病理解剖例中のLC57名と他疾患患者50名において心筋,腎皮質内の小動脈を用いて定量的に動脈硬化度を算出し,血清脂質を加え,両群で比較検討を行った.次に入院患者で,血清脂質とアポ蛋白を比較検討した.LCでは他疾患患者に比し動脈硬化の程度は肉眼的及び組織学的検討の双方で軽度であった.また.年齢別の硬化度は加齢に従い他疾患患者で増加,LCで低下し明らかな較差が見られた(p

A case of giant malignant schwannoma growing out of chest wall to intrathoracic space which was associated with von Recklinghausen disease and caused dyspnea is presented here. An 8-year-old male visited another hospital because of fever and cough, and a chest tumor extending from the right lateral chest wall to intrathoracic space was suspected. The patient was admitted to the hospital for operation, because he developed stridor and dyspnea due to a rapid growth of the tumor. In the right lateral chest, an elastic hard subcutaneous tumor (13.5×5cm) was noted. On chest X-ray and CT, right intrathoracic space was occupied by the tumor and the mediastinum was shifted to the left. Incision biopsy revealed a malignant shwanoma. The operation was performed by posterolateral approach. The tumor was subtotally resected in combination with the 4th and 5th rib. Reexpansion pulmonary edema occurred postoperatively, but was improved by artificial respiration and the dyspnea disappeared. Eight months later, however, he died of the regrowth of the tumor in spite of chemotherapy, second resection and radiation.

Transposition osteotomy of the acetabulum (TOA) was the first periacetabular osteotomy in which the acetabulum was transposed with articular cartilage. TOA improves coverage of the femoral head and joint congruity. The purpose of this study was to investigate whether TOA is an appropriate option for treating osteoarthritis of the hips at the advanced stage by comparing it with matched control hips at the early stage.Between 1998 and 2001, TOA was performed in 104 hips of 98 patients. Altogether, 16 of 17 hips (94%) with osteoarthritis at the advanced stage were examined and compared with 37 matched control hips at the early stage. The mean age at the operation was 48 years (38-56 years), and the mean follow-up period was 88 months (65-107 months).TOA corrected the acetabular dysplasia and significantly improved containment of the femoral head. Clinical scores were also significantly improved in both groups. In the advanced osteoarthritis cases, there was a tendency for abduction congruity before transposition osteotomy of the acetabulum to reflect the clinical outcome.TOA is a promising treatment option for advanced osteoarthritis of the hips as well as for patients at an early stage when preoperative radiographs show good congruity or containment of the joint.

Clinical in vivo and in vitro studies have revealed pronounced gastric cancer activity using the combination of 5-fluorouracil (5-FU) and cisplatin (CDDP). In addition, the combination of 5-fluorouracil plus cisplatin (FP treatment) possesses synergistic cytotoxicity against gastric cancer. Sensitivity of two gastric cancer cell lines to anti-cancer drugs, 5-fluorouracil (5-FU) and/or cisplatinum (CDDP), was evaluated by use of either flow cytometric analysis (FACS) or morphological observation in terms of induction of apoptosis. In morphological observation, a new experimental technique was used in which cancer cells were distributed in thin collagen gel as one or two cell layers, and cultured with anti-cancer drugs. Thereafter, cells were stained with fluorescent Hoechst 33258 (Ho) and photographed, then stained with hematoxylin and eosin (H&E) and photographed again. Cell death patterns were determined by combining observations of Ho- and H&E-stained cells. While combined administration of 5-FU and CDDP did not induce apoptosis of MKN-28 (mutant-type p53), apoptotic cells were markedly observed in the case of MKN45 (wild-type p53). In addition, consecutive administration of CDDP for 3 h and 5-FU for 21 h effectively induced apoptosis of MKN45. These results indicated that the type of p53 expression in cancer cells could be a promising factor in predicting response to FP therapy and the administration of CDDP prior to 5-FU may be more effective in inducing apoptosis of gastric cancer cells with wild-type p53 expression. These data may provide evidence to support the idea that p53 expression is related to multidrug resistance (MDR) in FP therapy of gastric cancer cell lines.

The combination of 5-fluorouracil (5-FU) plus Cisplatin (CDDP) (FP treatment) possesses synergistic cytotoxicity against colon cancer. The molecular mechanisms by which chemotherapeutic agents induce apoptosis have been clarified by identifying apoptosis-related genes such p53 and bcl-2. We previously established a new experimental technique in which cancer cells are distributed in thin collagen gel as 1 or 2 cell layers. additionally, we evaluated the efficacy and toxicity of FP treatment in the gastric and colon cancer cell lines, and examined the relationship between the response to FP treatment and apoptosis. In these results we reported transfection of normal p53 gene into p53 mutant and analyzed the impact of the p53 gene in a sensitivity test. In this study, we examined induced apoptosis in colon cancer cell lines and the status of p53 expression in response to treatment of HCT116, COLO320, SW480 and DLD1 with 5-FU alone, CDDP alone and FP treatment under flow cytometric analysis. Transfection of SW480 and DLD1 cells was performed to compare the chemosensitivity of naturally occurring mutant-type p53 SW480 and DLD1 cells with neo-transfected SW480 and DLD1 cells and transfected SW480 and DLD1 cells. Appreciable apoptosis was induced in HCT116 and COLO320 (p53 wild-type) but not in SW480 and DLD1 cells (p53 mutant-type). Transfected SW480 and DLD1 cells underwent significantly more apoptosis (p

Objective Progressive cirrhosis is associated with increasing difficulty to handle free water. We examined the therapeutic potential of an orally active nonpeptide vasopressin-2 receptor antagonist (OPC-31260) in the management of edema and ascites in patients with cirrhosis. By means of its chemical blockade of the vasopressin-2 receptor in the kidney, we also assessed the ability of renal water handling in the early stage of cirrhosis. Methods A single 30 mg dose of OPC-31260 was administered orally to eight biopsy-proven patients with cirrhosis who had ascites or peripheral edema. The aquaretic responses were compared with those in six healthy subjects. Results In the patients with cirrhosis, OPC-31260 significantly (p < 0.01) increased the urinary excretion rate at 0 to 2 hours, and significantly (p < 0.01) lowered urine osmolality at 2 to 4 hours after administration. Free water clearance increased from −0.48 ± 0.14 to +0.19 ± 0.21 ml/min (p < 0.05) at 0 to 4 hours after administration. However, these aquaretic responses in the patients with cirrhosis were only approximately half the responses observed in the healthy subjects. A significant (p < 0.05) inverse relationship was observed between indocyanine green retention at 15 minutes after administration and the maximal free water clearance after administration to the patients with cirrhosis. Urinary sodium excretion did not change significantly in the patients, whereas it increased twofold in the healthy subjects. Urinary vasopressin excretion tended to increase in the patients, whereas it increased twofold to threefold (p < 0.01 to 0.05) from the baseline in the healthy subjects. Urinary prostaglandin E2 excretion was not increased, and serum sodium and plasma vasopressin levels were elevated only slightly in both groups. Conclusions Even though a hyporesponsiveness was observed in the group of patients with cirrhosis compared with the healthy group, the novel vasopressin-2 antagonist induced hypotonic diuresis in patients with cirrhosis, suggesting a therapeutic potential in managing water excess. This drug response may be a new index to assess impairment of water handling in patients with cirrhosis. Clinical Pharmacology & Therapeutics (1998) 63, 561–570; doi