A walking support/evaluation machine for patients with parkinsonism

Various walk supporting systems have been devised and developed. However, they have not been designed for supporting or evaluating the gait of parkinsonian patients, and not much consideration has been given to gait disturbances of parkinsonian patients. In this study : (a) We prepared a tentative model of walk supporting and monitoring system in consideration of typical symptoms of parkinsonism. (b) We conducted gait rehabilitation in a parkinsonian patient using the walk supporting and monitoring system and confirmed (i) the occurrence of frozen gait during walking, (ii) brachybasia, (iii) the absence of anterior tilting of the posture, pulsion symptom, and festination, and (iv) occurrence of hesitation to start walking. Therefore, typical symptoms of parkinsonism can be detected by the use of this system. (c) The medical staff can evaluate the state of recovery of patients on the basis of the data obtained from this system and use them for purposes such as guidance of rehabilitation

セイシン ホケン フクシ ニオケル ガクサイテキ タショクシュ レンケイ ニヨル チーム ケア ノ コウカ ソクテイ

Despite great interests on interdisciplinary collaborative team care (ICTC) in psychiatric care, a limited number of studies regarding the practice of ICTC and its evaluation has been reported in Japan. There is little consistency in the selection of the outcome variables and the methods of measurement, so that the effectiveness of ICTC has not been clearly shown. The purpose of this article is to emphasize the needs for systematic evaluation of ICTC in psychiatric care, as well as to identify some methodological essentials for the evaluation research on the management innovation. Use of more a scientific research design, such as an experimental design with controlling of extraneous variables or an extensive qualitative research, and more adequate outcome variables and the instruments should be considered for the future research. The future diffusion of ICTC as a new health care model in Japan can depend on the researchers who recognize the importance of the evidence-based management, like as the evidence-based medicine, present scientific evidences on improved health care and reduced costs as the outcome of ICTC, and provide a guideline for the health care organizations to evaluate their practice of ICTC. Despite great interests on interdisciplinary collaborative team care (ICTC) in psychiatric care, a limited number of studies regarding the practice of ICTC and its evaluation has been reported in Japan. There is little consistency in the selection of the outcome variables and the methods of measurement, so that the effectiveness of ICTC has not been clearly shown. The purpose of this article is to emphasize the needs for systematic evaluation of ICTC in psychiatric care, as well as to identify some methodological essentials for the evaluation research on the management innovation. Use of more a scientific research design, such as an experimental design with controlling of extraneous variables or an extensive qualitative research, and more adequate outcome variables and the instruments should be considered for the future research. The future diffusion of ICTC as a new health care model in Japan can depend on the researchers who recognize the importance of the evidence-based management, like as the evidence-based medicine, present scientific evidences on improved health care and reduced costs as the outcome of ICTC, and provide a guideline for the health care organizations to evaluate their practice of ICTC

No association of the Trp 64 Arg mutation of the β3-adrenergic receptor gene with obesity, type 2 diabetes mellitus, hyperlipidemia, and hypertension in Japanese patients with schizophrenia

This study was conducted to address the question of whether the β3-adrenergic receptor gene mutation (Trp 64 Arg) is associated with metabolic disease in Japanese patients with schizophrenia. Methods : In a cross-sectional study, 89 participants were grouped into three genotypes. The 64 Arg allelic frequency in patients with or without metabolic disease was analyzed. Anthropometrics variables and biochemical parameters were compared among the genotypes. Results : The 64 Arg allele, which had a frequency of 0.22, was not associated with obesity, type 2 diabetes mellitus, dyslipidemias, or hypertension. No significant differences among the genotypes were found in current age, age at diagnosis with schizophrenia, body mass index, waist-hip ratio, plasma glucose, plasma insulin, triglycerides, free fatty acids. Patients with the 64 Arg allele had greater 24-h excretion of norepinephrine than those lacking the variant (p=0.019). Conclusion : The 64Arg allelic mutation is not associated with obesity, type 2 diabetes mellitus, lipid metabolism dysfunction, or hypertension in Japanese patients with schizophrenia

Real-time measurement of frozen gait in patient with parkinsonism using a sensor-controlled walker

Patients with Parkinson’s disease develop gait disturbances. Although the use of walkers is very effective for maintaining locomotive ability, patients who have symptoms such as frozen gait (FG) and festinating gait may fall even with a walker equipped with a brake as they cannot use the brake well in an emergency and fail to follow the accelerating walker. None of the studies on walking aids to date have addressed real-time detection of FG or the use of this information for the control of the walking aid, monitoring of the state of improvement in the ambulatory function, or evaluation of the effect of the use of a walker. In this study, we evaluated whether the state called FG, a characteristic symptom of Parkinson’s disease, can be detected by the use of a sensor-controlled walker with heel-to-toe pressure sensors. The following two measurements were carried out in one male healthy and a one male patient with stage 3 Parkinson’s disease by the Hoehn-Yahr scale showing mild muscle rigidity, hypokinesia, and FG. In the healthy subject, the heel-to-toe pressure showed smooth heel-to-toe shifts during the standing phase. In the patient with Parkinson’s disease, the heel-to-toe response time was about 2.4 times longer than in the healthy subject at the beginning of walking, and FG could be recorded as the difficulty in lifting the foot by the toes. Also, when FG was observed during walking, the pressure waves recorded by the same sensors showed two peaks occurring at a short interval, indicating double landings

Efficacy and surgical procedures of preoperative splenic artery embolization for laparoscopic splenectomy of a massive splenomegaly: A case report

Here, we describe the case of a 58-year-old woman diagnosed with massive splenomegaly with a malignant lymphoma that had a maximum diameter of 24 cm. Splenectomy was indicated because of thrombocytopenia and abdominal distention. Therefore, a balloon catheter was inserted preoperatively through the splenic artery for embolization and continuous infusion to reduce the spleen volume. It enabled easy handling of the spleen and minimized bleeding. The volume of the spleen was estimated at 1896 g through the skin incision, as measured by volumetric computed tomography; thus, laparoscopy seemed difficult. However, the surgery was successfully performed only with laparoscopic surgery, and the volume of the resected spleen was 1020 g. This preoperative preparation is an effective alternative to laparoscopic removal of a huge splenomegaly

Balloon-occluded retrograde transvenous obliteration for gastric varices via the intercostal vein

Gastric varices are usually associated with a gastro-renal (G-R) shunt. However, the gastric varices described in this case report were not associated with a G-R shunt. The inflow vessel was the posterior gastric vein and the outflow vessels were the narrow inferior phrenic vein and the dilated cardio-phrenic vein. First, percutaneous transhepatic obliteration of the posterior gastric vein was performed, but the gastric varices remained patent. Then, micro-balloon catheterization of the subphrenic vein was carried out via the jugular vein, pericardial vein and cardio-phrenic vein, however, micro-balloon-occluded inferior phrenic venography followed by micro-coil embolization of the cardio-phrenic vein revealed no delineation of gastric varices resulting in no further treatment. Thereafter, as a gastro-subphrenic-intercostal vein shunt developed, a micro-balloon catheter was advanced to the gastric varices via the intercostal vein and balloon-occluded retrograde transvenous obliteration (BRTO) was performed resulting in the eradication of gastric varices. BRTO for gastric varices via the intercostal vein has not previously been documented