著者

Yoshikazu Matsuda Tomoaki Terada Yu Sakamoto Minako Kubo Arisa Umesaki Yuko Tanaka Hiroaki Matsumoto Hiroo Yamaga Tomoyuki Tsumoto Tohru Mizutani

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2023-0032, (Released:2023-07-22)

参考文献数

14

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Objective: Recently, the occlusion rate of transarterial embolization (TAE) for intracranial non-sinus-type dural arteriovenous fistulas (NSDAVFs) has improved after ONYX was introduced. Additionally, when TAE for NSDAVF is unsuccessful, transvenous embolization (TVE) has become available as an alternative treatment. We investigated the factor for the favorable occlusion rate of endovascular treatment for NSDAVF at our institutions.Methods: Two hundred and twenty-seven patients with intracranial dural arteriovenous fistulas (DAVFs) were treated at our institutions between September 2014 and October 2022. The patients diagnosed with NSDAVF in all DAVFs who underwent endovascular treatment were included. The clinical characteristics, angiographical outcomes, and clinical outcomes of patients who underwent endovascular treatment were evaluated.Results: Thirty-eight patients had intracranial NSDAVF (tentorial: 23 cases, parasagittal-convexity: 7, anterior cranial fossa: 6, middle cranial fossa: 2). Our participants’ mean age was 64.8 ± 11.3 years, and 31 (81.6%) of them were males. Patients’ symptoms were as follows: asymptomatic (24), hemorrhage (10), tinnitus (3), and trigeminal neuralgia (1). TAE and TVE were performed on 35 and 3 patients, respectively. The rate of immediate angiographical occlusion was 84.2% (32/38). The follow-up angiographical occlusion rate in 6 months was 88.5% (31/35). Complications occurred in three cases. There was no morbidity or mortality after 30 days.Conclusion: TAE using the combination of the new microcatheter and microguidewire and TVE in the case of difficult or failed TAE for NSDAVF could achieve high success rates and safety.

著者

Takato Nakajo Tomoaki Terada Tomoyuki Tsumoto Yoshikazu Matsuda Hiroaki Matsumoto Sadayoshi Nakayama Tohru Mizutani

出版者

The Japanese Society for Neuroendovascular Therapy

雑誌

Journal of Neuroendovascular Therapy (ISSN:18824072)

巻号頁・発行日

pp.oa.2023-0028, (Released:2023-08-10)

参考文献数

15

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Objective: In the acute stage of ruptured cerebral aneurysms, limited devices are available, making the treatment difficult. We aimed to evaluate the outcomes of the coil embolization with stenting for the ruptured cerebral aneurysms in the acute stage.Methods: We assessed 22 cases treated with stenting among 134 of 169 consecutive patients with subarachnoid hemorrhages undergoing an endovascular treatment between April 2014 and December 2021, of which 134 underwent an embolization during the acute stage. A stent was used in the patients wherein the treatment with the balloon-assisted or double catheter technique was difficult. Stenting was performed under the loading of two or more antiplatelet agents.Results: The mean age of the patients was 68.9 years, of which five were male and 14 (63.6%) had severe grade (World Federation of Neurosurgeons grade IV, V). The aneurysm site was the anterior communicating artery in four cases, internal carotid artery in nine, middle cerebral artery in two, vertebrobasilar artery in six, and posterior cerebral artery in one. The aneurysm shape was saccular in 13 cases, dissection in seven, and fusiform in two. Stents were used for wide-neck aneurysms in 12 cases, vascular preservation in seven, and rescue in three. The mean maximum diameter was 9.6 mm. The mean neck size was 6.4 mm. Complete occlusion and neck remnant were found in eight and seven cases, respectively. The perioperative complication rate was 45.5% (thromboembolism in five cases, stent occlusion in two, re-bleeding in two, and cerebral hemorrhage in one). The outcomes included modified Rankin Scale 0–2 in seven cases, 4–5 in five, and 6 in nine. Stent-related death occurred in one case. The rate of morbidity and mortality was 18.2%. Although stents were used in the acute stage of rupture, they were used for the right reasons. However, a high rate of complications occurred: two cases of re-bleeding, in which an incomplete occlusion was a factor.Conclusion: Stent placement in patients with the acute ruptured cerebral aneurysms should be carefully determined and efforts should be made to reduce the embolic and hemorrhagic complications. However, it may be an effective treatment option when other options could be extremely difficult.

著者

Atsushi Ishimura Yutaka Shimizu Ayano Onishi Naohiro Yabuki Yoshikazu Matsuda

出版者

Japanese Society for Applied Therapeutics

雑誌

アプライド・セラピューティクス (ISSN:18844278)

巻号頁・発行日

vol.18, pp.16-21, 2023 (Released:2023-05-15)

参考文献数

14

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Magnesium oxide, a low-price laxative without a habit-forming tendency after long-term use, is widely used for treating constipation in Japan. However, its use has been associated with hypermagnesemia in patients with impaired magnesium excretion function such as renal insufficiency. Therefore, in this study, we investigated the use of magnesium oxide tablets, which may be administered to the elderly on a long-term basis. We found the total number of prescriptions has increased year by year and exceeded 4 billion tablets in FY 2020. The use and number of prescriptions were highest among individuals in their 80s, and more than 70% of patients taking the drug are aged 70 years or older. Since the elderly experience physiological functional decline, pharmacists must make effective use of not only age but also laboratory data listed on prescriptions when dispensing these medications in order to prevent adverse events.

著者

Atsushi Ishimura Yoshikazu Matsuda

出版者

Japanese Society for Applied Therapeutics

雑誌

アプライド・セラピューティクス (ISSN:18844278)

巻号頁・発行日

vol.17, pp.150-154, 2022 (Released:2022-12-28)

参考文献数

13

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Within Japan, national medical costs are continuing to increase owing to the aging population and advances in medical technologies. The market share occupied by generic drugs is still low compared with other countries. We investigated trends in the use of generic drugs (tablets) with introduced authorized generics (AGs) using National Database of Japan (NDB) Open Data. We evaluated the impact of introducing AGs on the transition to generic drugs. We found that more than 80% of drugs with AGs had generic usage rates exceeding 70%. AGs are often used to treat chronic diseases, such as hypertension. Branded drug manufacturer-approved AGs are considered associated with less negative perceptions; however, despite this, it remains difficult to say whether the introduction of AGs has promoted the use of generic drugs overall. Furthermore, we inferred that the timing of introduction to the market is vital for AGs. Considering the tight medical financial situation in Japan, shifting to the use of generic drugs, including AGs, would be favorable after patents for branded drugs expire. It is also necessary to conduct a detailed analysis of trends in the use of generic drugs, including AGs.