Nihon rinsho. Japanese journal of clinical medicine
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During the last decade, it has become increasingly clear that DBS represents a useful adjunct for therapies to control various symptoms of Parkinson's disease. The stimulation sites include the thalamic nucleus ventralis intermedius(Vim), globus pallidus internus(GPi) and subthalamic nucleus (STN). The clinical data of DBS therapy currently available from the literature, together with our own experience, are reviewed. ⋯ It thus attenuates dopa-induced dyskinesia through a reduced dose of medication. More importantly, the stimulation improves the daily activities in dopa-intolerant patients who are being administered a small dose of levodopa because of unbearable side effects. In addition, GPi stimulation has its own inhibitory effect on dopa-induced dyskinesia.
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The effects of current neurosurgical interventions for levodopa-induced dyskiensias (DID) in Parkinson's disease are reviewed. Thalamotomy has been reported to be effective for DID when the lesions include Vo or CM-Pf nucleus, while thalamic deep brain stimulation(DBS) is less effective than thalamotomy. ⋯ The effects of cerebral transplantation on DID remain undefined. More researches are expected to clarify the pathophysiology of DID.
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Review Comparative Study
[Cost-effectiveness of the treatment of reflux esophagitis: proton pump inhibitor versus histamine-2-receptor antagonist].
Gastroesophageal reflux disease(GERD) is a common condition and acid-suppressing agents are the mainstays of treatment. A clinical decision analysis comparing a proton pump inhibitor(PPI), lansoprazole and a histamine H2-receptor antagonist (H2RA), ranitidine for the treatment of reflux esophagitis in Japan was performed using a Markov chain approach. ⋯ The PPI first strategy is the preferred therapeutic approach for medical treatment of reflux esophagitis. We also recommend that prescription of PPIs for a one-month period be approved by the Japanese health insurance scheme.
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Hiatal sliding hernia is often found in aged patient and some of them contribute to the development of reflux esophagitis. We described the etiology of gastroesophageal reflux disease(GERD) briefly and mentioned the relationship between hiatal hernia and reflux esophagitis. The old patients suffers from GERD are accompanying hiatal hernia at the high rate. ⋯ We emphasize that we should not hesitate to perform the surgical treatment to the patients suffering from GERD with hiatal hernia or after gastrectomy because it is safe and bring them the better Q. O. L. after treatment.