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Clinical features of gastroduodenal injury associated with long-term low-dose aspirin therapy
Junichi Iwamoto,Yoshifumi Saito,Akira Honda,Yasushi Matsuzaki
World Journal of Gastroenterology , 2013, DOI: 10.3748/wjg.v19.i11.1673
Abstract: Low-dose aspirin (LDA) is clinically used for the prevention of cardiovascular and cerebrovascular events with the advent of an aging society. On the other hand, a very low dose of aspirin (10 mg daily) decreases the gastric mucosal prostaglandin levels and causes significant gastric mucosal damage. The incidence of LDA-induced gastrointestinal mucosal injury and bleeding has increased. It has been noticed that the incidence of LDA-induced gastrointestinal hemorrhage has increased more than that of non-aspirin non-steroidal anti-inflammatory drug (NSAID)-induced lesions. The pathogenesis related to inhibition of cyclooxygenase (COX)-1 includes reduced mucosal flow, reduced mucus and bicarbonate secretion, and impaired platelet aggregation. The pathogenesis related to inhibition of COX-2 involves reduced angiogenesis and increased leukocyte adherence. The pathogenic mechanisms related to direct epithelial damage are acid back diffusion and impaired platelet aggregation. The factors associated with an increased risk of upper gastrointestinal (GI) complications in subjects taking LDA are aspirin dose, history of ulcer or upper GI bleeding, age > 70 years, concomitant use of non-aspirin NSAIDs including COX-2-selective NSAIDs, and Helicobacter pylori (H. pylori) infection. Moreover, no significant differences have been found between ulcer and non-ulcer groups in the frequency and severity of symptoms such as nausea, acid regurgitation, heartburn, and bloating. It has been shown that the ratios of ulcers located in the body, fundus and cardia are significantly higher in bleeding patients than the ratio of gastroduodenal ulcers in patients taking LDA. Proton pump inhibitors reduce the risk of developing gastric and duodenal ulcers. In contrast to NSAID-induced gastrointestinal ulcers, a well-tolerated histamine H2-receptor antagonist is reportedly effective in prevention of LDA-induced gastrointestinal ulcers. The eradication of H. pylori is equivalent to treatment with omeprazole in preventing recurrent bleeding. Continuous aspirin therapy for patients with gastrointestinal bleeding may increase the risk of recurrent bleeding but potentially reduces the mortality rates, as stopping aspirin therapy is associated with higher mortality rates. It is very important to prevent LDA-induced gastroduodenal ulcer complications including bleeding, and every effort should be exercised to prevent the bleeding complications.
Ureteroscopy-Assisted Retrograde Nephrostomy (UARN) after Anatrophic Nephrolithotomy
Takashi Kawahara,Hiroki Ito,Hideyuki Terao,Yoshitake Kato,Takehiko Ogawa,Hiroji Uemura,Yoshinobu Kubota,Junichi Matsuzaki
Case Reports in Medicine , 2012, DOI: 10.1155/2012/164963
Abstract: Introduction. Open surgical anatrophic nephrolithotomy (ANL) had been the standard treatment for large renal calculi prior to the development of endoscopic devices and endoscopic techniques. A previous report described the efficacy of ureteroscopy-assisted retrograde nephrostomy (UARN) and presented a case of renal calculi successfully treated with UARN during percutaneous nephrolithotomy (PCNL) in a patient after ANL. Case Presentation. A 61-year-old male with left renal calculi was referred for further treatment. The patient was placed under general and epidural anesthesia, in a Galdakao-modified Valdivia position. A flexible ureteroscope (URS) was inserted, and a Lawson retrograde nephrostomy puncture wire was advanced into the flexible URS. The puncture wire then followed the route from the renal pelvis to the exit skin. Calculus fragmentation was undertaken using a pneumatic lithotripter. Conclusions. UARN for PCNL was therefore found to be a safe, effective, and appropriate treatment for a patient presenting with renal calculi after undergoing ANL.
Encrusted Ureteral Stent Retrieval Using Flexible Ureteroscopy with a Ho: YAG Laser
Takashi Kawahara,Hiroki Ito,Hideyuki Terao,Takehiko Ogawa,Hiroji Uemura,Yoshinobu Kubota,Junichi Matsuzaki
Case Reports in Medicine , 2012, DOI: 10.1155/2012/862539
Abstract: A 23-year-old female had bilateral ureteral stents placed due to bilateral renal stones and hydronephrosis. The bilateral ureteral stents were changed every 3 months. A kidney ureter bladder (KUB) film showed left encrustation along the ureteral stent thus necessitating removal; however, the ureteral stent could not be removed cystoscopically. The ureteral stent was, therefore, extracted using flexible ureteroscopy (URS) with a holmium (Ho): yttrium aluminum garnet (YAG) laser.
Ureteral Stent Retrieval Using the Crochet Hook Technique in Females
Takashi Kawahara, Hiroki Ito, Hideyuki Terao, Takuya Yamagishi, Takehiko Ogawa, Hiroji Uemura, Yoshinobu Kubota, Junichi Matsuzaki
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0029292
Abstract: Introduction We developed a method for ureteral stent removal in female patients that requires no cystoscopy or fluoroscopic guidance using a crochet hook. In addition, we also investigated the success rate, complications and pain associated with this procedure. Methods A total of 40 female patients (56 stents) underwent the removal of ureteral stents. All procedures were carried out with the patients either under anesthesia, conscious sedation, or analgesic suppositories as deemed appropriate for each procedure including Shock Wave Lithotripsy (SWL), Ureteroscopy (URS), Percutaneous Nephrolithotomy (PCNL), and ureteral stent removal. At the time of these procedures, fluoroscopy and/or cystoscopy were prepared, but they were not used unless we failed to successfully remove the ureteral stent using the crochet hook. In addition, matched controls (comprising 50 stents) which were removed by standard ureteral stent removal using cystoscopy were used for comparison purposes. Results A total of 47 of the 56 stents (83.9%) were successfully removed. In addition, 47 of 52 (90.4%) were successfully removed except for two migrated stents and two heavily encrusted stents which could not be removed using cystoscopy. Ureteral stent removal using the crochet hook technique was unsuccessful in nine patients, including two encrustations and two migrations. Concerning pain, ureteral stent removal using the crochet hook technique showed a lower visual analogue pain scale (VAPS) score than for the standard technique using cystoscopy. Conclusions Ureteral stent removal using a crochet hook is considered to be easy, safe, and cost effective. This technique is also easy to learn and is therefore considered to be suitable for use on an outpatient basis.
Ureteroscopy-assisted retrograde nephrostomy for lower calyx calculi in horseshoe kidney: two case reports
Takashi Kawahara, Hiroki Ito, Hideyuki Terao, Katsuyuki Tanaka, Takehiko Ogawa, Hiroji Uemura, Yoshinobu Kubota, Junichi Matsuzaki
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-194
Abstract: Case 1 was a 68-year-old man who was shown on radiography to have left lower calyx calculi (19?×?15mm, 7?×?5mm, and 7?×?3mm) in horseshoe kidney. Case 2 was a 36-year-old woman shown on radiography to have a left lower calyx calculus (10?×?8mm) in horseshoe kidney.Both patients were stone-free after ureteroscopy-assisted retrograde nephrostomy during percutaneous nephrolithotomy. Ureteroscopy-assisted retrograde nephrostomy is a promising procedure for safely and effectively treating lower calyx stones in horseshoe kidney.
Effectiveness of Ureteroscopy-Assisted Retrograde Nephrostomy (UARN) for Percutaneous Nephrolithotomy (PCNL)
Takashi Kawahara, Hiroki Ito, Hideyuki Terao, Yoshitake Kato, Hiroji Uemura, Yoshinobu Kubota, Junichi Matsuzaki
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0052149
Abstract: Objective To determine the impact of ureteroscopy-assisted retrograde nephrostomy (UARN) during percutaneous nephrolithotomy (PCNL). Materials and Methods From April 2009 to September 2011, a total of 50 patients underwent PCNL for large renal stones (stone burden >2 cm). We performed UARN in the Galdakao-modified Valdivia position for 27 patients (UARN PCNL) and ultrasonography-assisted percutaneous nephrostomy in the prone position for 23 patients (prone PCNL). Results UARN PCNL significantly improved the stone-free rate (81.5% vs 52.2%) and the rate of residual stones (<4 mm, 92.6% vs 65.2%, P<0.05). The median length of the operation was significantly shorter for UARN PCNL, at 160 min, compared to 299 min for prone PCNL (P<0.001). There was one intraoperative complication in prone PCNL, namely a hemorrhage that resulted in stopping the initial treatment, but it was cured conservatively. The postoperative complications included a high grade fever that persisted for three days in two UARN PCNL patients (7.4%) and six prone PCNL patients (26.1%). The Clavien grading scores showed significantly lower postoperative complications for UARN PCNL compared to prone PCNL. Conclusion UARN is associated with a higher stone-free rate, shorter operation time, and fewer complications during PCNL than prone PCNL.
Utility and Limitation of Cumulative Stone Diameter in Predicting Urinary Stone Burden at Flexible Ureteroscopy with Holmium Laser Lithotripsy: A Single-Center Experience
Hiroki Ito, Takashi Kawahara, Hideyuki Terao, Takehiko Ogawa, Masahiro Yao, Yoshinobu Kubota, Junichi Matsuzaki
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0065060
Abstract: Purpose To retrospectively assess the clinical utility in ureteroscopy (URS) planning of cumulative stone diameter (CSD), which does not account for stone width or depth, as a predictor of URS outcome and compare it with stone volume. Materials and Methods Patients with renal stones treated at a single institute by flexible URS were retrospectively evaluated. To assess the clinical utility of CSD, relationships between stone-free (SF) status and stone burden (CSD and volume) were analyzed using the area under the receiver operating characteristics (AUROC) curve. To identify stone number impact on CSD, the AUROC of CSD divided by stone number was evaluated. Correlation coefficients of CSD and stone volume were also calculated for groups by stone number. Results In cases with CSD <20.0 mm, CSD and stone volume revealed equal ability to predict SF status. In cases with CSD ≥20.0 mm, stone volume showed higher predictive ability. The ROC curves for cases with ≥4 stones showed that CSD was less predictive of SF status than stone volume. The correlation coefficients of CSD and stone volume by stone number were 0.922 for 1 stone, 0.900 for 2–3 stones, and 0.661 for ≥4 stones. Conclusions In cases with CSD ≥20.0 mm or ≥4 stones, we should evaluate stone volume for a more predictive stone burden, and pretreatment non-contrast CT seems sufficient. In cases with CSD <20.0 mm or 1–3 stones, CSD was as valid a predictor of preoperative stone burden as stone volume, so preoperative kidney-ureter-bladder (KUB) films may be sufficient.
Breast Surgery with Application of Doughnut Mastopexy Lumpectomy Technique  [PDF]
Kyoichi Matsuzaki
Modern Plastic Surgery (MPS) , 2012, DOI: 10.4236/mps.2012.24022
Abstract: Purpose: Doughnut mastopexy lumpectomy (DML) is a breast resection technique in which a tissue segment is removed and the breast reshaped through a doughnut-shaped de-epithelialized periareolar area. In this study, we attempted to determine whether the DML technique could be useful for other types of breast surgery, in addition to breast cancer lumpectomy. Methods: This study examined a total of 4 patients who underwent the DML technique and were followed up for at least 1 year postoperatively. One patient underwent phyllodes tumor resection, 1 patient underwent removal of a siliconoma, and 2 patients underwent breast reduction mammaplasty. Results: This method enabled en-bloc removal of a large tissue mass or large foreign body that could not be removed through a short periareolar incision. The surgical method of this study enabled the extent of de-epithelialization to be changed according to the size and location of the mass to be excised; good cosmetic results were also obtained. In addition, the surgical method enabled the facile excision of tumors and foreign materials. Conclusions: The DML technique is a useful surgical method that is applicable to other breast surgeries, in addition to breast cancer surgery.
Usefulness of Free Nipple-Areola Complex Graft for Nipple Malposition after Nipple Sparing Mastectomy  [PDF]
Kyoichi Matsuzaki
Modern Plastic Surgery (MPS) , 2012, DOI: 10.4236/mps.2012.24021
Abstract: Purpose: This article identifies the advantage and disadvantage of a free nipple areola complex graft (FNACG) for nipple malposition which resulted from tissue-expander insertion and subsequently replaced with an implant after nipple sparing mastectomy (NSM). Methods: The subjects were three such patients treated using FNACG and who were followed up for at least one year postoperatively. The surgical outcome was assessed for symmetry of nipple-areola position, graft take, depigmentation, and shrinkage. Results: In all patients, the graft was accurately transferred to a position to achieve symmetry with the unaffected breast, and there was complete graft take in the areola by simple surgical design and techniques. No depigmentation of the areola was observed. The size of the areola was almost unchanged after grafting in two patients, but areolar shrinkage occurred in one other patient. There was complete graft take in the nipple in one patient and no depigmentation of the nipple was observed. Necrosis occurred at the tip of the nipple in two other patients. These patients had depigmentation, and the height of nipples decreased in proportion to the level of necrosis. Conclusion: FNACG can be a useful method if its advantages and disadvantages are well considered.
Multiple Intelligence Theory Can Help Promote Inclusive Education for Children with Intellectual Disabilities and Developmental Disorders: Historical Reviews of Intelligence Theory, Measurement Methods, and Suggestions for Inclusive Education  [PDF]
Junichi Takahashi
Creative Education (CE) , 2013, DOI: 10.4236/ce.2013.49086

Inclusive education, based on the principle that all children (including those with disabilities) should receive similar education, has been recently adopted in primary and secondary schools throughout several countries. Within an inclusive education context, teachers are faced with the challenge of developing their knowledge and skills necessary to properly assess the intellectual abilities of a wide range of children. Although intelligence has been examined for over 100 years, researchers are still debating what abilities should or should not be classified as belonging to the domain of intelligence. In order to effectively apply intelligence theory and assessment methods for inclusive education, we compared traditional intelligence theory (Spearman’s two-factor model) with a more recent intelligence theory (Gardner’s multiple intelligence theory). Spearman’s theory focuses on elementary perceptual processes by using the single g factor, whereas Gardner’s theory recognizes several types of intelligence. On the basis of these reviews, we propose the utility of multiple intelligence theory for inclusive education, considering the various profiles of intelligence shown by children with intellectual disabilities and developmental disorders.

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