PubMed | Red Cross, Hamamatsu University School of Medicine, Chiba Kaihin Municipal Hospital, Nagoya University and 13 more.
Type: Journal Article | Journal: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography | Year: 2016
Several coronary artery Z score models have been developed. However, a Z score model derived by the lambda-mu-sigma (LMS) method has not been established.Echocardiographic measurements of the proximal right coronary artery, left main coronary artery, proximal left anterior descending coronary artery, and proximal left circumflex artery were prospectively collected in 3,851 healthy children 18years of age and divided into developmental and validation data sets. In the developmental data set, smooth curves were fitted for each coronary artery using linear, logarithmic, square-root, and LMS methods for both sexes. The relative goodness of fit of these models was compared using the Bayesian information criterion. The best-fitting model was tested for reproducibility using the validation data set. The goodness of fit of the selected model was visually compared with that of the previously reported regression models using a Q-Q plot.Because the internal diameter of each coronary artery was not similar between sexes, sex-specific Z score models were developed. The LMS model with body surface area as the independent variable showed the best goodness of fit; therefore, the internal diameter of each coronary artery was transformed into a sex-specific Z score on the basis of body surface area using the LMS method. In the validation data set, a Q-Q plot of each model indicated that the distribution of Z scores in the LMS models was closer to the normal distribution compared with previously reported regression models. Finally, the final models for each coronary artery in both sexes were developed using the developmental and validation data sets. A Microsoft Excel-based Z score calculator was also created, which is freely available online (http://raise.umin.jp/zsp/calculator/).Novel LMS models with which to estimate the sex-specific Zscore of each internal coronary artery diameter were generated and validated using a large pediatric population.
PubMed | Red Cross, Tottori Prefectural Central Hospital, Chiba Kaihin Municipal Hospital, Nara City Hospital and 10 more.
Type: Journal Article | Journal: Brain & development | Year: 2015
To determine the early changes and evolutions of brain diffusion-weighted imaging (DWI), and analyze prognostic factors of the early changes among patients with neonatal herpes simplex encephalitis (NHSE).We selected patients who developed encephalitis by 28 d after birth; had herpes simplex infection; and who underwent magnetic resonance imaging, including DWI, 7 d of symptom onset. Thirty-two DWI scans between 0 and 28 d after onset in 13 patients and the clinical data were recruited. The distribution, evolution of the lesions, and neurological outcome were analyzed.DWI frequently showed multiple cortical lesions in both hemispheres in the early period and both hemispheres on DWI (8/9 scans at 48 h, 7/7 patients). As time from onset increased, the cortical lesions tended to coincide with subcortical white matter lesions beneath the initial cortical lesions (p<0.01). Lesions from the cortex extended to the subcortical white matter in 7 patients. Deep cerebral lesions, involving basal ganglia, internal capsules, thalamus, were also found in 9 patients 7 d of onset. The distributions of deep cerebral lesions (none/unilateral/bilateral) 7 d of onset showed significant correlations with neurological prognoses (gross motor functions: p<0.01; developmental or intellectual quotient scores: p<0.01).Cortical lesions were main findings of DWI in NHSE in the early period. Bilateral deep cerebral lesions 7 d were highly indicative of poor motor and cognitive outcomes.
PubMed | Red Cross, Shinshu University, Chiba Kaihin Municipal Hospital, Kurume University and 14 more.
Type: | Journal: Journal of gastroenterology | Year: 2016
Hepatitis B eantigen (HBeAg)-negative inactive carriers, the majority of hepatitis B virus (HBV) carriers, are considered to have a good prognosis. The definition of the inactive HBV carrier state has been based on HBV DNA and alanine aminotransferase (ALT) levels. Here we conducted a prospective study involving 18 hospitals to clarify the prognosis of HBeAg-negative inactive carriers.Three hundred eighty-eight HBeAg-negative inactive carriers at the baseline were observed prospectively from January 2011 to November 2015. We evaluated the primary end point, defined as the development of cirrhosis, hepatocellular carcinoma (HCC), or liver-related death. Also, we analyzed the factors associated with inactive carrier dropout and markedly increased levels of ALT or HBV DNA or both during the follow-up period.At the baseline, the mean age was 57.513.1years and 42% of patients were male. No individual developed cirrhosis, HCC, or liver-related death during the follow-up period (1035252days). Loss of inactive carrier status was seen in 75 patients (19.3%). Factors associated with failure to meet the inactive carrier criteria in the multivariate analysis were the levels of ALT (hazard ratio 1.13, 95% confidence interval 1.07-1.19, p<0.001), HBV DNA (hazard ratio 2.70, 95% confidence interval 1.63-4.49, p<0.001), and -glutamyl transpeptidase (hazard ratio 1.01, 95% confidence interval 1.00-1.02, p=0.003) at the baseline.Most inactive carriers in Japan had a good prognosis. However, despite the short observation period, some patients had loss of IC status. The long-term prognosis of inactive carriers remains unclear; therefore, careful follow-up of inactive carriers is needed.
Nakamura J.,Chiba Childrens Hospital |
Nakamura J.,Chiba University |
Ohtori S.,Chiba University |
Sakamoto M.,Chiba Kaihin Municipal Hospital |
And 3 more authors.
Clinical and Experimental Rheumatology | Year: 2010
Objective: Systemic lupus erythematosus (SLE) patients are at high risk of developing osteonecrosis, as they require corticosteroid therapy for life. The purpose of this study was to use periodic MRI analysis to clarify (1) the incidence of new osteonecrosis associated with long-term corticosteroid therapy in SLE patients, and (2) the risk factors for delayed osteonecrosis in SLE patients. Methods: We prospectively studied 291 joints (134 hips and 157 knees) in 106 SLE patients without osteonecrosis after initial corticosteroid therapy, with a mean follow-up period of 13.6 years and a follow-up rate of 71%. All patients had undergone periodic MRI examination of the hip and knee joints for >10 years. Results: New osteonecrosis developed in 6 joints (3%) and only occurred after SLE recurrence in association with increased corticosteroid doses (to>30 mg/day [p=0.008]). New lesions were delayed for a mean 5.9 years after initial corticosteroid administration. The mean time from SLE recurrence to appearance of new lesions was 6.2 months. SLE recurrence occurred in 131 joints (45%), while SLE was well controlled in 160 joints (55%). Conclusion: We suggest that with respect to long-term effects, total cumulative dose and duration of corticosteroid therapy do not contribute to osteonecrosis. However, SLE recurrence is a risk factor for new osteonecrosis. We recommend MRI screening for osteonecrosis at SLE recurrence. © Copyright Clinical and Experimental Rheumatology 2010.
Tonooka T.,Chiba Kaihin Municipal Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013
We report a case of recurrent transverse colon cancer invading the pancreas and duodenum that was successfully treated with biliary and duodenal stenting. A 46-year-old man underwent ascending colostomy for the treatment of obstructive transverse colon cancer with hepatic metastasis. Chemotherapy achieved a partial response, but the levels of tumor markers later began to rise again. He then underwent right hemicolectomy and partial hepatectomy. Post-operative chemotherapy was administered, but the recurrent tumor caused obstructive jaundice and duodenal obstruction. These were successfully treated with biliary and duodenal stenting, and the patient was able to remain at home and maintain his quality of life.
Tonooka T.,Chiba Kaihin Municipal Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2012
We report a case of recurrent gastric cancer successfully treated by a combination of CPT-11 and CDDP as the third- line chemotherapy. A 78-year-old man with advanced gastric cancer underwent a curative distal gastrectomy. Three years later, the tumor marker level began to rise and computed tomography (CT) revealed lymph node metastasis invading the pancreas resulting in pancreatic duct dilatation. S-1 treatment was initiated but was discontinued because of a systemic exanthem. Paclitaxel was administrated as secondary chemotherapy. But, after 2 courses, a further increase in the tumor marker level and portal vein invasion were observed. Combination therapy of CPT-11 and CDDP was administered as the third-line chemotherapy. After 3 courses, the tumor marker level normalized, tumor size decreased, and the invasion was eliminated. Third-line chemotherapy against recurrent gastric cancer should be considered if patient performance status (PS) is maintained.
Tonooka T.,Chiba Kaihin Municipal Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2011
We report a case of mediastinal lymph node metastasis from rectal cancer successfully treated by carbon ion radiotherapy. A 65-year-old woman underwent sigmoid colostomy against unresectable rectal cancer. After chemoradiotherapy, primary rectal cancer became resectable and low anterior resection was performed. Curative local resection was done and chemoradiotherapeutic effect was grade 2. Chemotherapy after the operation wasn't effective enough and the size of the mediastinal lymph node increased. So she underwent carbon ion radiotherapy (52.8 Gy) which markedly decreased the lymph node size (-48%). Multi-modality therapy, such as radiation, chemotherapy, operation and carbon ion radiotherapy was applied. Successfully, locally advanced rectal cancer was resected and distant lymph node metastasis was controllable.
Yamaguchi S.,Chiba Kaihin Municipal Hospital |
Asakura T.,Saitama University |
Miura S.,Saitama University |
Ohki T.,Jikei University School of Medicine |
And 4 more authors.
General Thoracic and Cardiovascular Surgery | Year: 2013
A 61-year-old man had a Stanford type A acute aortic dissection, and the total aortic arch was replaced with 22-mm knitted Dacron graft in 1996. In 2006, he underwent mitral valve replacement and tricuspid valve repair due to severe mitral and tricuspid valve regurgitation. Although preoperative computed tomography (CT) scan suggested pseudoaneurysm around the Dacron graft replaced with aortic arch, it could not be repaired concomitantly. Four months later, in view of the technical difficulties of an open surgical procedure, the prosthetic graft failure was repaired by endovascular stent graft consisting of a Gianturco Z stent covered with an UBE woven Dacron graft. However, during a follow-up, aneurysm sac diameter increased without any sings of endoleak in follow-up CT scans. Redo endovascular stent graft placement using a Gore-TAG device was performed. Subsequently, shrinkage of the pseudoaneurysmal sac could be observed. © 2012 The Japanese Association for Thoracic Surgery.
PubMed | Chiba Kaihin Municipal Hospital
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2016
A 44-year-old woman with subileus was diagnosed with advanced sigmoid colon cancer with a synchronous liver metasta- sis (segmanet 5/8). Laparoscopic anterior resection was performed, and histological diagnosis was sigmoid colon cancer, 5540 mm, type 2, tub2>por2, pT3, ly2, v2, pN1, M1a, Stage (Japanese Classification of Colorectal Carcinoma, Eighth edition). Four courses of neoadjuvant chemotherapy (FOLFIRI plus panitumumab) shrank the liver metastasis. Laparoscopic partial liver resection was performed for 285 minutes, with 350 g of blood loss. The patient was discharged 9 days after the operation. Two courses of oral adjuvant chemotherapy (S-1) was performed but discontinued owing to side effects. Seven months after the surgery, computed tomography revealed 2 small liver metastasis (segment 8). Although the sizes were 35 and 5 mm, respectively, the larger mass was closed to the middle and right hepatic vein. Therefore, open hepatectomy was performed for 285 minutes, with 525 g of blood loss. The patient was discharged 9 days after the operation without complication. The patient had no recurrence for 1 year after the last surgery.
PubMed | Chiba Kaihin Municipal Hospital
Type: Case Reports | Journal: Pediatrics international : official journal of the Japan Pediatric Society | Year: 2013
Acute scrotum is a rare complication of acute Kawasaki disease (KD), less well recognized than other disease manifestations. We describe the cases of two patients, aged 59 months and 19 months, with hydrocele testis in the acute phase of KD. Scrotal ultrasound and trans-illumination were used in the diagnosis of hydrocele testis. One patient underwent eventual surgical intervention. We reviewed the literature for a better understanding of the pathogenesis of scrotal symptoms in acute KD and investigated the clinical importance of hydrocele testis. Careful further clinical observation may elucidate the true incidence of this extracardiac symptoms, thereby clarifying the diagnostic value of this possible complication in acute KD.