ノウシュッケツ ト クモマクカ シュッケツ ノ チリョウ

We reviewed recent advances in the treatment of hypertensive intracerebral hemorrhage(HIH) and subarachnoid hemorrhage (SAH). The mortality rate of patients with HIH, approximately50% in McKissock’s time (around 1960), was reduced to 20% due to the disseminationof improved diagnostic imaging technologies, advances in medical and surgical treatmentregimens, and an increase in the detection rate of mild cases of HIH. On the otherhand, the mortality rate of SAH patients remained unchanged (approximately 50%) becausepatients experiencing the insult were often of advanced age and because the number ofpatients graded as poor has increased.To treat patients with HIH, we developed a new surgical approach that we call “CT-guidedstereotactic aspiration surgery (SAS)”. We also devised an ultrasonic hematoma aspirator.SAS is beginning to supplant conventional open surgery. SAS may be indicated for patientswith putaminal hemorrhage where the hematoma volume is greater than 30ml, and forpatients with cerebellar hemorrhage with a hematoma volume greater than 15ml. On theother hand, open surgery may be indicated for patients with subcortical hemorrhage wherethe hematoma volume is greater than 40ml. It is not indicated for patients with pontine andthalamic hemorrhage. The efficacy and safety of SAS in patients with pontine and thalamichemorrhage remain to be determined and to our knowledge, no randomized study of role ofSAS in patients with HIH has been reported. Such a study (Surgical Trial in IntracerebralHemorrhage, STICH) is planned in the UK to ascertain operative indications.There have been some advances with respect to diagnostic equipment and the managementof SAH. Three-dimensional CT angiography (3D-CTA), using a helical CT scan, andmagnetic resonance imaging angiography (MRA) have yielded superior images of cerebralaneurysms when compared with digital subtraction angiography (DSA). The titanium clipmarkedly reduces metallic artifacts on CT images. The complete clipping of aneurysms withtitanium clips can be ascertained by postopertive 3D-CTA. A recent Japanese cooperativestudy revealed a decrease in the mortality rate of SAH patients graded as poor. However,grade V patients (World Federation of Neurological Surgery) continue to have a poor outcome.Mild hypothermia induced with indomethacine, an antagonist of cyclooxygenase,may improve the treatment outcome. The cumulative rate of rupture of cerebral aneurysmswas estimated at approximately 1 - 2% per year, however a recent paper shows it tobe 0.05% per year. An unruptured cerebral aneurysms study (UCAS Japan) will start nextyear in Japan. It will reveal ruptre risk and the risks inherent in surgical intervention inpatients with unruptured cerebral aneurysms

Unilateral chronic insufficiency of anterior cruciate ligament decreases bone mineral content and lean mass of the injured lower extremity

We studied the effects of unilateral chronic anterior cruciate ligament (ACL) injury on bone size, bone mineral content (BMC), bone mineral density (BMD), soft tissue composition and muscle strength of the injured lower extremity in Japanese 21 men and 12 women aged 15 to 39 years. Bone area, BMD, BMC, lean mass and fat mass of lower extremity were measured using dual energy X-ray absorptiometry. The isometric and isokinetic muscle strength was assessed by an isokinetic machine. BMC, lean mass, circumference of the thigh and circumference of the lower leg of the injured lower extremity were significantly smaller than those of the intact lower extremity (p=0.0002, p<0.0001, p<0.0001, p=0.0131). In cotrast, fat mass and %Fat of the injured lower extremity was significantly greater than that of the intact lower extremity (p= 0.0301, p<0.0001). Bone area and BMD did not produce significant difference. These findings suggest that chronic insufficiency of ACL decreases BMC and lean mass of the injured lower extremity

Long-term outcome of severe stroke patients : Is the ADL status at discharge from a stroke center indicative of the long-term outcome?

The objective of this study was to examine the possibility of predicting the longterm outcome of severe stroke patients from the ADL status at discharge. The design is a retrospective observational study in the stroke center at Tokushima University Hospital. Severe stroke patients at discharge with Barthel Index (BI) scores 40 (N=51) were divided into two subgroups retrospectively, improved and unimproved. The Functional Independence Measure (FIM) and BI were analyzed at discharge, 3 and 6 months after onset. Correlation analysis between BI and FIM showed good correlation, especially between BI and motor FIM (mFIM). In conclusion, the ADL status at discharge from a stroke center is not definitely indicative of the long-term outcome, although good recovery of severe stroke cases was observed in males and younger patients, and in patients with motor FIM score 25. This result shows that the first 3 months after the attack should be regarded as an important time window for intensive rehabilitation

Early ambulation after total knee arthroplasty prevents patients with osteoarthritis and rheumatoid arthritis from developing postoperative higher levels of D-dimer

This study aimed to clarify the therapeutic effects of postoperative ambulation after total knee arthroplasty (TKA) on deep venous thrombosis (DVT) in patients with osteoarthritis (OA) and rheumatoid arthritis (RA) after TKA. Subjects of this study were thirty-seven inpatients (21 inpatients : OA, 16 inpatients : RA) undergoing TKA (32 female and 5 male). Subjects were divided into two groups, deep venous thrombosis (DVT) group (n=25) and non-DVT group (N group, n=12). The cutoff value was 10.0 g/ml plasma D-dimer level measured on 7th postoperative day. The N group was below the cutoff value. Another cutoff value divided into two groups, ambulatory group (n=26) and non-ambulatory group (n=11). Ambulatory group was the date of ambulation beginning below 7th day. Statistical analysis confirmed that all subjects showed a significant correlation to the date of ambulation. Postoperative ambulation beginning had strong association with the level of D-dimer (r=0.71). Group comparison showed that the non-ambulatory group had significant higher values of D-dimer than ambulatory group (P=0.022). Typical case supported these results. Postoperative early ambulation within a week after TKA kept patients with OA and RA after TKA lower level of D-dimer

Three dimensional motion analyses for rehabilitation version of Awa Odori exercise and the expectancy of physical effects

‘Awa Odori Exercise -Rehabilitation version- was developed in 2006 for the new trial of physical exercise for the aging and the impaired person with lower balance performance in Tokushima prefecture, Japan. Public relations of this exercise had been spreading over Tokushima since then. The characteristics of the exercise were highly familiar with most of people in Tokushima because of popularity in original ‘Awa Odori’. This study proposed the efficacies of Awa Odori Exercise as a rehabilitation exercise. This exercise expected the flexible balance reinforcements and the substitution for walking training with prevention of fall, bedridden and participating restriction for the old people, also promoting the health in Tokushima

Gait and posture assessments of a patient treated with deep brain stimulation in dystonia using three-dimensional motion analysis systems

Kinesiologic analysis of gait disorders, postural instabilities and abnormal movements is quite difficult to assess objectively by clinical observation, such as by specific scale and video recordings. In this study, we reported one of the aspects of the usefulness of three-dimensional motion analysis (Vicon Systems, Oxford, United Kingdom), which can measure inclusive data of movement disorders and substitute for conventional assessments. A 49-year-old man who had various dystonic symptoms, mainly on his left side of the body, responded well to deep brain stimulation (DBS). The examination quantified how the involuntary movements or other symptoms with dystonia changed before and after treatments

Relationship between Barthel Index scores during the acute phase of rehabilitation and subsequent ADL in stroke patients

The Barthel Index (BI) cannot be used to measure initial stroke severity or by extension, to stratify patients by severity in acute stroke trials because most patients are bedbound in the first few hours after stroke, either by their deficit or by medical directive. Our objectives were to clarify the threshold of acute BI for use in the prediction of subsequent independence in activities of daily living (ADL) and to assist in the definition of acute stroke rehabilitation goals. Subjects comprised 78 patients out of 191 inpatients admitted with acute stroke at our hospital during 2006-2007. The BI ADL score was divided into 2 ranges (BI≧60 and≦40), in a process similar to previous studies. During the acute period (from onset to approximately 3 weeks), all patients with a BI≧40 could improve their ADL in 6 months. Patients with a BI≦40 exhibited two ADL recovery outcomes (improved and no change) at 6 months. We also found that the skill level of basic activities related to standing was significant indicator of BI improvement (P<0.001). BI scores determined at approximately 3 weeks were reliable predictors of ADL disabilities at 6 months

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Abstract : The Barthel Index (BI) cannot be used to measure initial stroke severity or by extension, to stratify patients by severity in acute stroke trials because most patients are bedbound in the first few hours after stroke, either by their deficit or by medical directive. Our objectives were to clarify the threshold of acute BI for use in the prediction of subsequent independence in activities of daily living (ADL) and to assist in the definition of acute stroke rehabilitation goals. Subjects comprised 78 patients out of 191 inpatients admitted with acute stroke at our hospital during 2006-2007. The BI ADL score was divided into 2 ranges (BI 60 and 40), in a process similar to previous studies. During the acute period (from onset to approximately 3 weeks), all patients with a BI 40 could improve their ADL in 6 months. Patients with a BI 40 exhibited two ADL recovery outcomes (improved and no change) at 6 months. We also found that the skill level of basic activities related to standing was significant indicator of BI improvement (P &lt;0.001). BI scores determined at approximately 3 weeks were reliable predictors of ADL disabilities at 6 months. J. Med. Invest. 57 : 81-88, February, 201