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Biomedical subjects

Kenji Maeda

Publications and source records attributed to Kenji Maeda.

At least 55 records · Page 3Linked to original sources
PubMed2003

[Neuroendoscopic treatment for Rathke's cleft cyst: transventricular approach to suprasellar cystic lesion].

We report a case of a Rathke's cleft cyst, which was successfully treated by neuroendoscopy. The endoscopic procedure for the intra-suprasellar cystic lesion used the transventricular approach, similar to that of third ventriculostomy. A 66-year-old woman suffered from headache, nausea and constriction of the visual field. Magnetic resonance imaging (MRI) on admission showed an intra-suprasellar cystic lesion. Biopsy of the cyst wall and fenestration of the floor of the third ventricle was performed using an endoscopic transventricular approach. The cyst content was totally aspirated, using a suction system which was connected to the operation channel of the endoscope. The histological diagnosis was Rathke's cleft cyst. No post-operative complication was observed. The endoscopic transventricular approach is safe and most suitable in terms of minimum invasiveness for the intrasuprasellar cystic lesion. We consider that neuroendoscopic transventricular approach will become the common surgical method of choice for treating a suprasellar cystic mass lesion.

Aged↗
PubMed2003

[Nutrition management based on urine collection in patients under home care].

We calculate the salt intake, the protein intake and the % creatinine generation rate, the index for the muscle volume/exercise, based on the sodium, urea and creatinine level in the urine in patients under home care and retain the data in the database. To date, 45 patients under home care have been enrolled. The mean age is 70.9 years (+/- 13.8, SD). The underlying disease treated under home care include malignant tumor in 23 patients (51.1%), cerebrovascular disorders in 11 patients (24.4%), neurological/muscular disorders in 6 patients (13.3%) and other diseases in 5 patients (11.1%). The analysis of the data obtained from the collected urine has revealed that the % creatinine generation rate was significantly low in the patients with neurological/muscular disorders and that the % creatinine generation rate, the protein intake and the salt intake were high in the patients under the central venous nutrition. The analysis has also revealed that the % creatinine generation rate and the protein intake were lower in the patients who are less independent in daily lives. These findings substantiate that the 24-hour urine collection is useful for the assessment of nutritional condition in patients under home care.

Aged↗
PubMed2003

[Involvement of Daikou Sunabashi Clinic in home care to home death].

Daikou Sundabashi Clinic provides continuous advanced medical treatment and visiting nursing services for patients with serious diseases till their death at home. The clinic has been involved in home care of 72 patients in total during the period from April 2002 to July 1 of 2003. Of the patients, 40 patients died to date and 71% (32 patients) of them died at home. 49 of the 72 patients (70%) had terminal cancer and mostly required advanced home care. The clinic provides services according to the following principles till the death of the patients: 1. All of our medical staff pool their information and stay in very close communication with one another. 2. The attending physician gives a complete explanation of the patient's condition to his/her family. 3. The staffs respond to emergency calls around the clock using 2 cell phones. Under this very meticulous and fast-response system, seriously ill patient can receive continuous and high-quality treatment at home and die at home even if the family is not adequately capable of providing care.

Aged↗
PubMed2003

[Pain control at home in cooperation with hospitals].

At present, many patients heavily dependent on medical care live at home. Therefore, the need for pain control at home is increasing. Within the limits of home care, the method used to control pain control is very important. Here we report 2 cases who need more than 1,000 mg of morphine (converted into oral administration). And we introduce our method for pain control at home. Our method is as follows: 1. Before the patient is discharged from the hospital, we go to the hospital and confirm the patient's condition and pain. 2. If necessary, before the patient is discharged from the hospital, we request to change instruments for home care. 3. We select the best way (instruments, circuits, administration) in consideration of the patients' or their families ADL. 4. When we change a route from oral administration to injection, we let the patient enter the hospital temporarily to adjust the quantity of morphine.

Activities of Daily Living↗
PubMed2003

[Method for home parenteral nutrition (HPN) at Daikou Sunadabashi Clinic].

In recent years many patients who have become heavily dependent on medical care live at home. At Daikou Sunadabashi Clinic, we take care of many patients who have malignant tumors, at their homes. They need many medical treatments, so HPN has become a common practice. Here we show our circumstances of HPN. And we introduce our method for HPN. Our method is as follows: 1. Before the patient is discharged from the hospital, we go to the hospital and confirm the patient's condition. 2. We assess the level of training regarding HPN, and select the best way (instruments, circuits, administration) in consideration of the patients' or their families ADL. 3. We select a visiting nurse station 4. and train the visiting nurse in HPN using our manuals. 5. We use an HPN pump. 6. We select a simple way of infusion and adjust it to the patient's condition. In this way, we use HPN easily at home with the aid of a visiting nurse, visiting pharmacist, families, and us.

Activities of Daily Living↗
PubMed2003

[Survey on the attitude of families which have taken care of patients until their death at home].

The results of our survey using a questionnaire were as follows: 1. patients' families had a positive attitude toward the patients' death at home, 2. a good communication was established between the nurses from our institution and the patients or their families, 3. the nurses were considered reliable and friendly, 4. for several days or immediately before the patients' death, which was the most severe period for the patients and their families, the patients and their families needed more support from the nurses.

Aged↗
PubMed2003

[Nutrition management based on urine collection in patients under home care].

We calculate the salt intake, the protein intake and the % creatinine generation rate, the index for the muscle volume/exercise, based on the sodium, urea and creatinine level in the urine in patients under home care and retain the data in the database. To date, 45 patients under home care have been enrolled. The mean age is 70.9 years (+/-13.8, SD). The underlying disease treated under home care include malignant tumor in 23 patients (51.1%), cerebrovascular disorders in 11 patients (24.4%), neurological/muscular disorders in 6 patients (13.3%) and other diseases in 5 patients (11.1%). The analysis of the data obtained from the collected urine has revealed that the % creatinine generation rate was significantly low in the patients with neurological/muscular disorders and that the % creatinine generation rate, the protein intake and the salt intake were high in the patients under the central venous nutrition. The analysis has also revealed that the % creatinine generation rate and the protein intake were lower in the patients who are less independent in daily lives. These findings substantiate that the 24-hour urine collection is useful for the assessment of nutritional condition in patients under home care.

Aged↗
PubMed2003

[Involvement of Daikou Sunadabashi Clinic in home care to home death].

Daikou Sunadabashi Clinic provides continuous advanced medical treatment and visiting nursing services for patients with serious diseases till their death at home. The clinic has been involved in home care of 72 patients in total during the period from April 2002 to July 1 of 2003. Of the patients, 40 patients died to date and 71% (32 patients) of them died at home. 49 of the 72 patients (70%) had terminal cancer and mostly required advanced home care. The clinic provides services according to the following principles till the death of the patients: (1) All of our medical staff pool their information and stay in very close communication with one another. (2) The attending physician gives a complete explanation of the patient's condition to his/her family. (3) The staffs respond to emergency calls around the clock using 2 cell phones. Under this very meticulous and fast-response system, seriously ill patient can receive continuous and high-quality treatment at home and die at home even if the family is not adequately capable of providing care.

Aged↗
PubMed2003

[Pain control at home in cooperation with hospitals].

At present, many patients heavily dependent on medical care live at home. Therefore, the need for pain control at home is increasing. Within the limits of home care, the method used to control pain control is very important. Here we report 2 cases who need more than 1,000 mg of morphine (converted into oral administration). And we introduce our method for pain control at home. Our method is as follows: (1) Before the patient is discharged from the hospital, we go to the hospital and confirm the patient's condition and pain. (2) If necessary, before the patient is discharged from the hospital, we request to change instruments for home care. (3) We select the best way (instruments, circuits, administration) in consideration of the patients' or their families ADL. (4) When we change a route from oral administration to injection, we let the patient enter the hospital temporarily to adjust the quantity of morphine.

Analgesics, Opioid↗
PubMed2003

[Method for home parenteral nutrition (HPN) at Daikou Sunadabashi Clinic].

In recent years many patients who have become heavily dependent on medical care live at home. At Daikou Sunadabashi Clinic, we take care of many patients who have malignant tumors, at their homes. They need many medical treatments, so HPN has become a common practice. Here we show our circumstances of HPN. And we introduce our method for HPN. Our method is as follows: (1) Before the patient is discharged from the hospital, we go to the hospital and confirm the patient's condition. (2) We assess the level of training regarding HPN, and select the best way (instruments, circuits, administration) in consideration of the patients' or their families ADL. (3) We select a visiting nurse station (4) and train the visiting nurse in HPN using our manuals. (5) We use an HPN pump. (6) We select a simple way of infusion and adjust it to the patient's condition. In this way, we use HPN easily at home with the aid of a visiting nurse, visiting pharmacist, families, and us.

Activities of Daily Living↗
PubMed2003

[Survey on the attitude of families which have taken care of patients until their death at home].

The results of our survey using a questionnaire were as follows: (1) patients' families had a positive attitude toward the patients' death at home, (2) a good communication was established between the nurses from our institution and the patients or their families, (3) the nurses were considered reliable and friendly, (4) for several days or immediately before the patients' death, which was the most severe period for the patients and their families, the patients and their families needed more support from the nurses.

Attitude↗
PubMed2002

In-patient interventions supported by results of randomized controlled trials in Japan.

OBJECTIVE: To determine to what extent the results of randomized controlled trials (RCTs) support medical interventions for in-patients at the department of general medicine of a university hospital in Japan. DESIGN: Retrospective analysis. By reviewing discharge summaries, two physicians first independently decided on patients' respective primary problems at admission and up to two secondary problems. Next, up to five interventions for the primary problem and one intervention for each of the secondary problems were selected. Differences of opinion (if any) between the two physicians regarding these selected interventions were resolved by discussion. MEDLINE and/or the Cochrane Library were used as data sources for literature regarding the selected interventions. SETTING: A ward of the department of general medicine of a Japanese university hospital, 1995-1997. MAIN MEASURES: The proportion of therapeutic interventions supported by RCT results and associated meta-analyses. RESULTS: For the primary problems, 103 (48.8%) of the 211 most important interventions were supported by the results of RCTs, as were 47.8% of all the interventions including the most important and the adjunctive ones. Furthermore, 56.2% of the most important interventions for the secondary problems were also supported by the RCT results. CONCLUSIONS: Approximately half of the therapeutic interventions performed at an academic medical in-patient unit in Japan were RCT-supported. This was true not only for the most important interventions for primary problems but also for the adjunct interventions for the primary problems and the interventions for secondary problems.

Adolescent↗
PubMed2002

A potent human immunodeficiency virus type 1 protease inhibitor, UIC-94003 (TMC-126), and selection of a novel (A28S) mutation in the protease active site.

We identified UIC-94003, a nonpeptidic human immunodeficiency virus (HIV) protease inhibitor (PI), containing 3(R),3a(S),6a(R)-bis-tetrahydrofuranyl urethane (bis-THF) and a sulfonamide isostere, which is extremely potent against a wide spectrum of HIV (50% inhibitory concentration, 0.0003 to 0.0005 microM). UIC-94003 was also potent against multi-PI-resistant HIV-1 strains isolated from patients who had no response to any existing antiviral regimens after having received a variety of antiviral agents (50% inhibitory concentration, 0.0005 to 0.0055 microM). Upon selection of HIV-1 in the presence of UIC-94003, mutants carrying a novel active-site mutation, A28S, in the presence of L10F, M46I, I50V, A71V, and N88D appeared. Modeling analysis revealed that the close contact of UIC-94003 with the main chains of the protease active-site amino acids (Asp29 and Asp30) differed from that of other PIs and may be important for its potency and wide-spectrum activity against a variety of drug-resistant HIV-1 variants. Thus, introduction of inhibitor interactions with the main chains of key amino acids and seeking a unique inhibitor-enzyme contact profile should provide a framework for developing novel PIs for treating patients harboring multi-PI-resistant HIV-1.

Alanine↗
PubMed2002

Risk factors for IgA nephropathy: a case-control study with incident cases in Japan.

BACKGROUND/AIM: Our previous study with prevalent cases suggested that some genetic, immunological and lifestyle-related factors increased the risk of immunoglobulin A nephropathy (IgAN). To confirm this hypothesis, we conducted another case-control study. METHODS: The study included 116 incident cases and 276 sex-, age- and residence-matched controls in central Japan. Information on family and individual history and on lifestyle was collected using a self-administered questionnaire. The strength of association between IgAN and a potential risk factor was assessed by calculating an odds ratio. RESULTS: A family history of chronic glomerulonephritis, susceptibility to the common cold, episodes of tonsillitis in the preceding year, preference for salty foods and a high intake of rice and n-6 polyunsaturated fatty acids (PUFA) were associated with an increased risk of IgAN. Coffee consumption and dietary calcium intake were somewhat negatively related to the risk. A significance of alcohol drinking, use of vitamin supplements, consumption of raw eggs and intake of nutrients other than n-6 PUFA and calcium, though previously suggested, was not shown in the present study. CONCLUSION: Our findings imply that some genetic factors, immune response to infections in the upper respiratory tract and nutritional imbalance would promote the development of IgAN.

Adult↗
PubMed2002

Changes in Mac-1 and CD14 expression on monocytes and serum soluble CD14 level during push/pull hemodiafiltration.

BACKGROUND/AIM: Employment of treated dialysate as replacement fluid raises concerns about exposure of patients to pyrogenic substances. This study was undertaken to evaluate the safety of treated dialysate as the replacement fluid for push/pull hemodiafiltration. METHODS: In the present study, changes in the expressions of Mac-1 and CD14 on monocytes, which are upregulated by monocyte activation, were analyzed by flow cytometry, and the serum level of sCD14 which elevates by monocyte activation was measured by enzyme-linked immunosorbent assay (ELISA) during treatment in 7 patients on hemodialysis with regenerated cellulose (RC) membrane, polysulfone (PS) membranes and by push/pull hemodiafiltration (HDF) with PS membranes in a cross-over fashion. RESULTS: During hemodialysis with RC, hemodialysis with PS or push/pull hemodiafiltration with PS, both Mac-1 and CD14 expressions on monocytes significantly increased by passing through the artificial kidneys, and, accordingly, the respective values downstream of the artificial kidneys were significantly higher than the predialysis values, even when the lipopolysaccharide level in dialysate was not detectable by Limulus assay. There was no significant variation in serum sCD14 levels during any of the hemodialysis with RC, hemodialysis with PS or push/pull hemodiafiltration. However, during hemodialysis with PS or push/pull hemodiafiltration with PS, changes in Mac-1 and CD14 expression on monocytes were significantly smaller than those during hemodialysis with RC. CONCLUSION: Monocytes are activated to a greater extent during hemodialysis with RC membranes than during push/pull HDF with PS membranes. We consider that push/pull HDF may be safer than hemodialysis with RC membrane and that it is as safe as hemodialysis with the PS membrane in terms of monocyte activation, when pyrogen-free dialysate is employed.

Adult↗