Chiba Cerebral and Cardiovascular Center

Ichihara, Japan

Chiba Cerebral and Cardiovascular Center

Ichihara, Japan
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Masuda K.,University of Tsukuba | Ishizu T.,University of Tsukuba | Niwa K.,St Lukes International Hospital | Takechi F.,Chiba Cerebral and Cardiovascular Center | And 3 more authors.
International Journal of Cardiology | Year: 2017

Background: Atrial tachyarrhythmias are a major morbidity in patients with adult congenital heart disease (ACHD). However, few studies have investigated risk stratification of thromboembolic events in ACHD patients with atrial tachyarrhythmias. Methods and results: This retrospective cohort study reviewed the clinical records of 2314 ACHD patients from 1977 to 2014. We found 242 (10.4%) patients with atrial tachyarrhythmias and excluded 84 patients already being treated with anticoagulant therapy. The remaining 158 patients without anticoagulant therapy were retrospectively followed up from the onset of atrial tachyarrhythmia to the incidence of thromboembolic events. Fourteen thromboembolic events and 5 hemorrhagic events occurred. All patients with thromboembolic events had atrial fibrillation (AF). Thromboembolic events occurred even in the patients with low or intermediate risk as indicated by CHADS2 or CHA2DS2-VASc score. Event rates were higher than those in data from the general adult population in previous studies. Univariate analysis revealed that age≥60years (OR 4.54, 95% CI 1.47-14.06, P =0.009), vascular disease (OR 7.83, 95% CI 1.19-51.53, P =0.032), and persistent AF (OR 5.60, 95% CI 1.73-18.11, P =0.004) were the independent risk factors of thromboembolic events. Conclusions: ACHD patients with atrial tachyarrhythmias and even those with low or intermediate risk as indicated by the CHADS2 or CHA2DS2-VASc score had a higher risk of thromboembolic events. Therefore, anticoagulation should be considered earlier than in the general population in patients with risk factors of age≥60years, vascular disease, or persistent AF. © 2017 Elsevier B.V.

Machida T.,Chiba Cerebral and Cardiovascular Center | Higuchi Y.,Chiba University | Nakano S.,Chiba Cerebral and Cardiovascular Center | Ishige S.,Chiba Cerebral and Cardiovascular Center | And 4 more authors.
Stroke | Year: 2017

Background and Purpose-Venous oxygen saturation (SO2) is measured in medical fields to assess tissue circulation insufficiency. This study aimed to elucidate the use of a cortical venous redness measurement to evaluate hemodynamic changes during revascularization surgery for patients with moyamoya disease. Methods-In this retrospective case-series analysis, we first quantitatively measured and correlated SO2 and R intensity of 24-bit color digital red-green-blue pictures of blood samples from 3 volunteers. Subsequently, based on intraoperative digital pictures of 29 patients with moyamoya disease, we measured the R intensities of a cortical vein near the anastomosis site before and after anastomosis. Cerebral blood flow (CBF) at the site was measured using a single-photon emission computed tomography before and 1 to 3 days after surgery. Venous R intensity and CBF were measured twice by 4 raters, and their correlations were examined using generalized linear mixed effect model and linear regression analysis. Results-A strong linear correlation was found between blood R intensity and its SO2 (coefficients, 0.522; 95% confidence interval, 0.364-0.680, using generalized linear mixed effect model). Venous R intensity before the anastomosis was not correlated with preoperative CBF (coefficients, 0.000352; 95% confidence interval,-0.000369 to 0.00107, by generalized linear mixed effect); however, the increases in venous R intensity after anastomosis were correlated with postoperative increases in CBF (R2, 0.367; 95% confidence interval, 0.116-0.618 to 0.548; 95% confidence interval, 0.331-0.764, by linear regression analysis). Conclusions-Cortical venous redness represented impaired CBF and could be a useful parameter for assessing hemodynamic changes during revascularization surgery. © 2017 American Heart Association, Inc.

Kawasaki K.,Chiba Cerebral and Cardiovascular Center | Matsumoto M.,Chiba Cerebral and Cardiovascular Center | Kase M.,Chiba Cancer Center | Nagano O.,Chiba Cerebral and Cardiovascular Center | And 2 more authors.
Radiological Physics and Technology | Year: 2017

In stereotactic radiosurgery for intracranial lesions, optimization of the dose to the at-risk organs is important to avoid neurological complications. We aimed to quantify the dose to the pyramidal tract (PT) and improve treatment planning for gamma knife radiosurgery by combining tractography. Pyramidal tractography images were depicted in 23 patients with lesions adjacent to the PT and fused with stereotactic magnetic resonance images. We regarded the PT as an at-risk organ and performed dose planning. To assess the efficacy of this process, we compared clinical parameters between plans with and without tractography. In the plans with tractography, the maximum PT dose was significantly reduced, although the irradiation time was prolonged by 3.5 min. There was no significant difference in the dose covering 95% of the lesion volume (D95). This result suggests that the PT dose can be reduced while maintaining the D95 with clinically acceptable prolongation of the irradiation time. © 2017 Japanese Society of Radiological Technology and Japan Society of Medical Physics

PubMed | Chiba Cerebral and Cardiovascular Center
Type: | Journal: World neurosurgery | Year: 2016

Although uncommon, subcortical low-intensity (SCLI) changes on fluid-attenuated inversion recovery (FLAIR) images are observed in various pathologies, including cerebral ischemia. Here we aimed to clarify the incidence and clinical implications of SCLI changes after revascularization surgery for moyamoya disease (MMD), focusing on the correlation with postoperative transient neurological events (TNEs).In this retrospective case series analysis, we included 10 hemispheres from 9 adults with MMD who underwent revascularization surgery. Subcortical signal intensity at the five gyri around the anastomosis point was quantitatively measured at 1 week and 3 months postoperatively. Changes in cerebral blood flow (CBF) were assessed using single photon emission computed tomography.Images taken 1 week post-surgery showed widespread SCLI changes below the operative fields in all ten cases, but these changes normalized by 3 months. Additionally, the changes in signal intensity at anastomoses negatively correlated with the changes in CBF (REarly after surgery, SCLI changes are common findings below the operative fields but negatively correlate with increases in CBF. Although no significant association was found between TNEs and the SCLI changes, the synchronized development of these phenomena may suggest a common underlying pathogenesis.

PubMed | Shonan Fujisawa Tokushukai Hospital, Komaki City Hospital, Kouseikai Takai Hospital, Shinsuma Hospital and 15 more.
Type: Journal Article | Journal: Journal of neurosurgery | Year: 2016

OBJECTIVE This study aimed to explore the efficacy and safety of stereotactic radiosurgery in patients with jugular foramen schwannomas (JFSs). METHODS This study was a multiinstitutional retrospective analysis of 117 patients with JFSs who were treated with Gamma Knife surgery (GKS) at 18 medical centers of the Japan Leksell Gamma Knife Society. The median age of the patients was 53 years. Fifty-six patients underwent GKS as their initial treatment, while 61 patients had previously undergone resection. At the time of GKS, 46 patients (39%) had hoarseness, 45 (38%) had hearing disturbances, and 43 (36%) had swallowing disturbances. Eighty-five tumors (73%) were solid, and 32 (27%) had cystic components. The median tumor volume was 4.9 cm

PubMed | Shonan Fujisawa Tokushukai Hospital, Komaki City Hospital, Tokyo Women's Medical University, Osaka City General Hospital and 7 more.
Type: Journal Article | Journal: Journal of neurosurgery | Year: 2016

The aim of this study was to explore the efficacy and safety of stereotactic radiosurgery for patients with facial nerve schwannomas (FNSs).This study was a multiinstitutional retrospective analysis of 42 patients with FNSs treated with Gamma Knife surgery (GKS) at 1 of 10 medical centers of the Japan Leksell Gamma Knife Society (JLGK1301). The median age of the patients was 50 years. Twenty-nine patients underwent GKS as the initial treatment, and 13 patients had previously undergone surgery. At the time of the GKS, 33 (79%) patients had some degree of facial palsy, and 21 (50%) did not retain serviceable hearing. Thirty-five (83%) tumors were solid, and 7 (17%) had cystic components. The median tumor volume was 2.5 cm(3), and the median prescription dose to the tumor margin was 12 Gy.The median follow-up period was 48 months. The last follow-up images showed partial remission in 23 patients and stable tumors in 19 patients. Only 1 patient experienced tumor progression at 60 months, but repeat GKS led to tumor shrinkage. The actuarial 3- and 5-year progression-free survival rates were 100% and 92%, respectively. During the follow-up period, 8 patients presented with newly developed or worsened preexisting facial palsy. The condition was transient in 3 of these patients. At the last clinical follow-up, facial nerve function improved in 8 (19%) patients, remained stable in 29 (69%), and worsened in 5 (12%; House-Brackmann Grade III in 4 patients, Grade IV in 1 patient). With respect to hearing function, 18 (90%) of 20 evaluated patients with a pure tone average of 50 dB before treatment retained serviceable hearing.GKS is a safe and effective treatment option for patients with either primary or residual FNSs. All patients, including 1 patient who required repeat GKS, achieved good tumor control at the last follow-up. The incidence of newly developed or worsened preexisting facial palsy was 12% at the last clinical follow-up. In addition, the risk of hearing deterioration as an adverse effect of radiation was low. These results suggest that GKS is a safe alternative to resection.

PubMed | Tokyo Women's Medical University, Sendai Cardiovascular Center, Nihon University, National Defense Medical College and 10 more.
Type: | Journal: Heart and vessels | Year: 2016

Although some studies have attempted to find useful prognostic factors in hypertrophic cardiomyopathy (HCM), those results are not fully helpful for use in actual clinical practice. Furthermore, several genetic abnormalities associated with HCM have been identified. However, the genotype-phenotype correlation in HCM remains to be elucidated. Here, we attempted to assess patients with different types of gene mutations causing HCM and investigate the prognosis. A total of 140 patients with HCM underwent a screening test for myofilament gene mutations by direct sequencing of eight sarcomeric genes. Patients with a single mutation in cardiac troponin T, cardiac troponin I, -tropomyosin, and regulatory and essential light chains were excluded from the study because the number of cases was too small. The clinical presentations and outcomes of the remaining 127 patients with HCM, 31 -myosin heavy chain (MYH7) mutation carriers, 19 cardiac myosin-binding protein C (MYBPC3) mutation carriers, and 77 mutation non-carriers were analyzed retrospectively. MYBPC3 mutation carriers had a high frequency of ventricular arrhythmia and syncope. Kaplan-Meier curves revealed no significant difference in prognosis among the three groups, but a lack of family history of sudden death (SD) and a past history of syncope were significantly related to poor prognosis. An absence of family history of SD and past history of syncope are useful prognostic factors in patients with HCM. MYH7 and MYBPC3 mutations did not significantly influence prognosis compared to non-carriers. However, patients with the MYBPC3 mutation should be closely followed for the possibility of SD.

Hirono S.,Chiba University | Iwadate Y.,Chiba University | Higuchi Y.,Chiba University | Serizawa T.,Tokyo Gamma Unit Center | And 3 more authors.
Journal of Neuro-Oncology | Year: 2015

The efficacy of stereotactic radiosurgery (SRS) instead of whole brain radiotherapy (WBRT) following high-dose methotrexate (HD-MTX) for primary central nervous system lymphoma (PCNSL) is unclear. To clarify whether SRS in combination with up-front HD-MTX supplements the effect of HD-MTX in remaining or refractory lesions after initial HD-MTX treatment. The authors conducted a retrospective review for newly diagnosed PCNSL patients who underwent SRS after HD-MTX as a first-line treatment. The local control (LC), the progression-free survival (PFS), the recurrence patterns, the salvage treatments, the overall survival (OS), the Karnofsky Performance Status (KPS), the activities of daily living (ADL) were analyzed as well as radiosurgical parameters. Twenty patients underwent SRS for 51 lesions with the median volume of 0.45 cm3. The median age at SRS was 67 (range 37–82). The median KPS at SRS was 90. The LC rate at 2 years was 86.0 %, the median PFS after SRS was 17 months, necessitating additional SRS and chemotherapy. The median OS was 52 months. No significant side effects related to SRS were observed. During follow-up period, the good ADL preservation was achieved for 13 months from SRS. Patients with KPS ≥ 90 at SRS demonstrated longer ADL preservation (32 months from SRS). SRS following up-front HD-MTX without WBRT provided excellent LC, acceptable OS and the long ADL preservation period. These benefits may be more emphasized especially in patients with good KPS, but should be validated in a large patient population. © 2015, Springer Science+Business Media New York.

PubMed | Hamamatsu University School of Medicine, Chiba University, Toho University and Chiba Cerebral and Cardiovascular Center
Type: | Journal: Clinica chimica acta; international journal of clinical chemistry | Year: 2015

Although increased circulating levels of malondialdehyde-modified low-density lipoprotein (MDA-LDL) are associated with coronary artery disease (CAD), there is no direct evidence that increased MDA-LDL is a prognostic factor for CAD.Forty-two patients (20 diabetic and 22 non-diabetic patients) who underwent percutaneous coronary intervention (PCI) were enrolled, and their baseline MDA-LDL levels were determined by immunoassay. Follow-up coronary angiography was performed at 2 to 7 months post-PCI. The patients were then divided into 2 groups, with in-stent restenosis (ISR) (n=13) and without ISR (n=29), and the baseline MDA-LDL levels were compared. We also studied 34 diabetics with CAD for up to 57 months until the onset of the next coronary event.In the diabetic patients, the mean MDA-LDL level was significantly higher in those with ISR than in those without ISR (151+/-61 vs. 90+/-26 U/l, p=0.010). A baseline MDA-LDL value of 110 U/l for differentiating between diabetics with and without ISR was defined as the cut-off value. Kaplan-Meier analysis demonstrated that a circulating MDA-LDL of 110 U/l correlated significantly with a higher prevalence of cardiac events than MDA-LDL <110 U/l (p=0.032).Circulating MDA-LDL is a useful prognostic marker for future cardiac event in diabetic patients with CAD.

PubMed | Chiba Emergency Medical Center and Chiba Cerebral and Cardiovascular Center
Type: | Journal: Asian cardiovascular & thoracic annals | Year: 2016

A 78-year-old man presented with back pain and shock and was transferred to our hospital. Computed tomography showed a ruptured aortic dissection in which the false lumen was thrombosed with an ulcer-like projection, and the mid-esophagus was shifted to the right due to a mediastinal hematoma. He underwent emergency thoracic endovascular aortic repair of the descending thoracic aorta. One week later, esophageal necrosis occurred, and he died of mediastinitis and sepsis on postoperative day 16. Although esophageal necrosis is a rare and fatal complication after thoracic endovascular aortic repair, a management strategy has not yet been established.

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