Tominaga hospital

a:2:{s:4:"lang";s:2:"en";s:7:"content";s:1471:"<h3>Objective</h3> This randomized, double-blind (DB) phase 3 trial evaluated rimegepant for preventive treatment of migraine in participants living in Japan. <h3>Methods</h3> Participants took rimegepant 75 mg or placebo every other day (EOD) during a 12-week DB phase, followed by rimegepant 75 mg EOD and up to once daily as needed on non-scheduled dosing days during a 40-week open-label phase. Hierarchical testing was used for efficacy endpoints to control for multiplicity. Safety assessments included adverse events and laboratory test abnormalities. DB phase data are presented. <h3>Results</h3> 484 (efficacy) and 496 (safety) treated participants were evaluable. During a 28-day pre-treatment observation period (OP), participants reported a mean±SD of 9.3±3.08 (rimegepant) and 9.0±3.14 (placebo) MMDs. The primary endpoint was met with a statistically significant difference in mean change from OP in the number of MMDs in the last 4 weeks of the DB phase for rimegepant vs placebo (difference –1.1 [95% CI –1.73, –0.38], p=0.0021). Given the first secondary endpoint was not statistically significant, formal hypothesis testing did not proceed, but results for secondary efficacy endpoints favoured rimegepant vs placebo. Rimegepant was well tolerated. <h3>Conclusions</h3> Rimegepant 75 mg EOD demonstrated efficacy superior to placebo for migraine prevention with a favourable safety profile. grant.oneil{at}pfizer.com ";}

IntroductionThe early and accurate diagnosis of primary headaches is essential for improving patients’ quality of life and preventing the overuse of acute medications. Lack of a proper diagnosis not only reduces the patients’ quality of life but also may result in patients having to return to other medical facilities or undergo duplicate tests, which has a negative impact on the health care system, including increasing medical costs. In Japan, although primary headaches are prevalent, studies investigating the misdiagnosis and underdiagnosis of headaches are limited. This study aimed to explore current trends in primary headache diagnosis and investigate how these diagnoses changed during the five years following the initial diagnosis.MethodsWe used an anonymized, nationwide health insurance claim database from Japan, which contained data from July 2010 through November 2024. We included the outpatient claim data of adults aged 18 years or older. Using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), we classified headache diagnoses into five categories: migraine and medication-overuse headaches (MOHs), tension-type headaches (TTHs), trigeminal autonomic cephalalgia (TACs), other primary headaches, and other headaches including secondary headaches. Cases with no specific headache diagnosis based on the ICD-10 were classified as unconfirmed. We assessed diagnostic consistency between the initial diagnosis and 3, 6, 12, 36, and 60 months later.ResultsWe analyzed data from 336,596 patients. The mean (SD) age was 40.2 (12.3) years. Overall, 91,830 patients (27.3%) were men and 244,766 (72.7%) were women. Regarding the initial diagnoses, 95,890 (28.5%) were unconfirmed diagnoses, 181,651 (54.0%) were migraine or MOH, 56,296 (16.7%) were TTH, 853 (0.3%) were TACs, 1,663 (0.5%) were other primary headaches, and 243 (0.1%) were other headaches. Of the 86,164 patients (25.6%) who had a definitive headache diagnosis three to five years after their initial visit, 51,360 (59.6%) received the same diagnosis at their initial visit and subsequent visit. The most common headache diagnosis after three to five years was migraine or MOH (n=67,939; 78.8%), followed by TTH (n=17,371; 20.2%), other primary headaches (n=488; 0.6%), TACs (n=307; 0.4%), and other headaches (n=59; 0.07%). The most frequent diagnostic change was from a TTH diagnosis to a migraine or MOH diagnosis (n=2,522; 2.9%).ConclusionsOver one in four patients received an unconfirmed diagnosis during their initial visit and more than 40% of patients were given different diagnoses during a later follow-up. These findings indicate the challenges and delays associated with reaching a definitive diagnosis for primary headaches.

This paper examines advancements in minimally invasive posterior decompression techniques for lumbar degenerative diseases. It focuses on the unilateral approach for bilateral decompression and bilateral approach for contralateral decompression, in which the entry side is determined independently of the symptomatic side to achieve a facet joint preservation rate of ≥ 70%, while also emphasizing contralateral foraminal decompression(CFD). These techniques address spinal instability by minimizing facet joint resection, reducing postoperative instability. CFD is noteworthy because it enables single-stage decompression in the same surgical field as foraminal stenosis, which frequently coexists with spinal canal stenosis. Additionally, this paper discusses the effectiveness of real-time 3D CT navigation in enhancing surgical precision, especially in complex cases, to improve long-term outcomes by minimizing postoperative instability. Furthermore, exoscopic surgery is evaluated as a future standard, highlighting its superior ergonomics and flexible viewing angles, including steep oblique angles, which are challenging with conventional microscopes. Although exoscopic technology offers many advantages, it also has certain drawbacks and remains in the developmental stage; however, it holds the potential to become a new paradigm in spinal surgery. Balancing minimally invasive approaches with spinal stability remains critical for optimizing patient recovery, reducing complications, and minimizing reliance on spinal fusion surgery.

A 34-year-old Japanese man developed bilateral periorbital pain and cranial autonomic symptoms that mimicked cluster headache after carotid artery stenting. Imaging revealed hemorrhagic infarction and multifocal vasoconstriction, confirming reversible cerebral vasoconstriction syndrome (RCVS). He had a history of radiotherapy for nasopharyngeal carcinoma, which likely contributed to the delayed vascular injury, including carotid stenosis and vertebral artery dissection. Combined with procedural stress from stenting, these factors may have triggered the RCVS. This case highlights the importance of considering RCVS in patients presenting with atypical headaches after endovascular intervention, particularly in those with prior radiation exposure. Repeat neuroimaging is crucial for a timely diagnosis.

See the article "Quantitative Comparison of Vertebral Structural Changes After Percutaneous Vertebroplasty Between Unilateral Extrapedicular Approach and Bilateral Transpedicular Approach Using Voxel-Based Morphometry" in Volume 20 on page 1287.