Nihon rinsho. Japanese journal of clinical medicine
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Periarthritis scapulohumeralis, also known as frozen shoulder, is a common disease in which the patient has a painful and restricted range of active and passive shoulder motion involving capsular contraction with no identifiable cause. Pathogenesis is thought to be a progression of inflammation and fibrosis of the capsule. ⋯ The natural progression of a frozen shoulder includes three phases (freezing, frozen and thawing) over a duration of 1 to 3.5 years and resolves spontaneously. Conservative treatment includes physical therapy and medication for pain relief but arthroscopic capsular release is sometimes performed in refractory cases.
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Patients with masked hypertension show normal office blood pressure but elevated out-of-office blood pressure. Out-of-office blood pressure is evaluated by ABPM (ambulatory blood pressure monitoring) or HBPM (home blood pressure measurements). HBPM is more popular in Japan because its simplicity. ⋯ Patients with masked hypertension have increased cardiovascular morbidity risk as high as seen in those with established hypertension. Many factors, including life style (smoking, excessive alcohol drinking, etc), variability of blood pressure (morning surge, non-dipper, riser) and inappropriate treatment of hypertension, are involved in masked hypertension. Life style modification, strict and sophisticated blood pressure control, and treatment of underlying diseases are necessary to treat masked hypertension.
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Early morning hypertension and morning blood pressure surge have been reported to be associated with organ damage and cardiovascular events. The concept of early morning hypertension and morning blood pressure surge is sometimes discussed in the same arena, and provides partly overlapping information concerning their mechanism or risk profile. ⋯ First, early morning hypertension is blood pressure level, while morning blood pressure surge is variability of blood pressure. Second, the intervention of early morning hypertension is available, which lead to prevent the progression of organ damage or cardiovascular event, but there is not enough evidence whether the reduction of morning blood pressure surge would reduce cardiovascular outcome.
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Anticoagulants are recommended for preventing stroke in patients with non-valvular atrial fibrillation (NVAF). Warfarin has been the most common oral anticoagulant for several decades, but use of warfarin has many limitations. Recently, several novel anticoagulants that can overcome the limitations of warfarin have been developed, and some of them are already used in clinical practice in Japan. In this review, we overview the pharmacological mechanisms and the results of the phase III trial of the novel anticoagulants for preventing stroke in patients with NVAF based on the comparison to warfarin.
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In the past, unfractionated heparin and warfarin have been used as anticoagulants for treatment of venous thromboembolism in Japan. Although it has been effective anticoagulants, these uses are accompanied by several pitfalls, which have led to research and the discovery of new additional groups of anticoagulants: parenteral factor Xa inhibitors, such as fondaparinux, and oral direct factor Xa inhibitors, such as rivaroxaban, apixaban and edoxaban. These new anticoagulants are fast-acting, noninferior to heparin and warfarin in preventing recurrence of venous thromboembolism, and do not require monitoring. These new anticoagulants show promise for improvement of long-term outcome for venous thromboembolism.