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Chigasaki, Japan

Nezu U.,University of Ryukyus | Kamiyama H.,Yokohama City University | Kondo Y.,Chigasaki Municipal Hospital | Sakuma M.,Hyogo College of Medicine | And 2 more authors.
BMJ Open | Year: 2013

Objective: To evaluate the effect of low-protein diet on kidney function in patients with diabetic nephropathy. Design: A systematic review and a meta-analysis of randomised controlled trials. Data sources: MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov, International Standard Randomised Controlled Trial Number (ISRCTN) Register and University Hospital Medical Information Network-Clinical Trials Registry (UMIN-CTR) from inception to 10 December 2012. Internet searches were also carried out with general search engines (Google and Google Scholar). Study selection: Randomised controlled trials that compared low-protein diet versus control diet and assessed the effects on kidney function, proteinuria, glycaemic control or nutritional status. Primary and secondary outcome measures and data synthesis: The primary outcome was a change in the glomerular filtration rate (GFR). The secondary outcomes were changes in proteinuria, post-treatment value of glycated haemoglobin A1C (HbA1c) and posttreatment value of serum albumin. The results were summarised as the mean difference for continuous outcomes and pooled by the random effects model. Subgroup analyses and sensitivity analyses were conducted regarding patient characteristics, intervention period, methodological quality and assessment of diet compliance. The assessment of diet compliance was performed based on the actual protein intake ratio (APIR) of the low-protein diet group to the control group. Results: We identified 13 randomised controlled trials enrolling 779 patients. A low-protein diet was associated with a significant improvement in GFR (5.82 ml/min/ 1.73 m2, 95% CI 2.30 to 9.33, I2=92%; n=624). This effect was consistent across the subgroups of type of diabetes, stages of nephropathy and intervention period. However, GFR was improved only when diet compliance was fair (8.92, 95% CI 2.75 to 15.09, I 2=92% for APIR <0.9 and 0.03, 95% CI -1.49 to 1.56, I 2=90% for APIR ≤0.9). Proteinuria and serum albumin were not differed between the groups. HbA1c was slightly but significantly decreased in the low-protein diet group (-0.26%, 95% CI -0.35 to -0.18, I2=0%; n=536). Source


Tsuchiya T.,Chigasaki Municipal Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2013

An 79-year-old man underwent right upper lobectomy with mediastinal lymph node dissection for lung cancer. He was discharged without complications on postoperative day( POD) 8. However, on POD 16 he become dyspneic at home and was transported to a hospital by ambulance. Pulmonary thromboembolism (PTE) was detected by contrast-enhanced computed tomography. Anticoagulant therapy was initiated and inferior vena cava filter placement was performed.Due to its many possible clinical manifestations, early detection of postoperative PTE is difficult. Therefore prevention of PTE is thought to be more important. Intermittent application of pneumatic compression stockings and preventive anticoagulant therapy may help prevent PTE after surgery. Source


Tsuchiya T.,Chigasaki Municipal Hospital
Kyobu geka. The Japanese journal of thoracic surgery | Year: 2012

A 38-year-old woman was referred to our hospital because she presented with an abnormal shadow on a chest radiograph. A through examination showed an aberrant artery arising from the abdominal aorta and supplying the right basal segment and patent ductus arteriosus(PDA).Moreover the sequestrated lung was not recognized. Based on these findings we diagnosed the patient with anomalous systemic arterial supply to the basal segment of the right lung with PDA. Her pulmonary-to-systemic blood flow ratio was 1.10. Therefore we planned to treat the PDA someday afterwards. Right basal segmentectomy and transection of the aberrant artery by using only autosuturing device were performed. Five months later, three-dimensional computed tomography showed no aneurysm of the cut end of the abnormal vessel. Source


Ueda N.,Yokohama City University | Satoh S.,Chigasaki Municipal Hospital | Kuroiwa Y.,Yokohama City University
Neurologist | Year: 2011

A 44-year-old woman was admitted to our hospital with altered mental status and weakness in the left upper and lower limbs. A brain magnetic resonance imaging indicated multiple cerebral infarctions in the bilateral frontal and parietal lobes and in the left occipital lobe. Magnetic resonance angiography indicated overall arterial wall irregularity and stenosis. An electrocardiogram showed negative T waves, troponin I was elevated at 0.60 ng/mL, and an echocardiogram showed severe hypokinesis, leading to a diagnosis of ischemic heart disease; however, no stenosis was found at cardiac catheterization. No other etiology for the angiopathy could be found. Whole-body computed tomography demonstrated an adrenal tumor and urinary catecholamine levels were elevated. Following excision of the adrenal tumor, a diagnosis of pheochromocytoma was made. Postoperatively, the patient's arterial stenosis and cardiac abnormalities improved. It was hypothesized that the patient's cardiomyopathy and vasospasm were secondary to excessive catecholamine secretion from the pheochromocytoma. Copyright © 2011 by Lippincott Williams & Wilkins. Source


Kondo Y.,Chigasaki Municipal Hospital | Kondo Y.,Yokohama City University | Satoh S.,Chigasaki Municipal Hospital | Nagakura J.,Chigasaki Municipal Hospital | And 3 more authors.
Journal of Diabetes Investigation | Year: 2013

Aims/Introduction: To define a set of criteria using indices of β-cell function, including results from the glucagon stimulation test, for liraglutide introduction in patients with type 2 diabetes. Materials and Methods: In the present retrospective cohort study, patients were included in our analysis if their β-cell function had been evaluated with a glucagon stimulation test and a 24-h urinary C-peptide (U-CPR) excretion test before switching from insulin therapy to liraglutide monotherapy. The efficacy of liraglutide was determined by the extent to which glycemic control was achieved or if glycated hemoglobin levels were maintained at <7.0% after liraglutide monotherapy for 24 weeks. Results: Liraglutide was effective in 36 of 77 patients. In the liraglutide-effective cases, the following parameters were higher: fasting C-peptide (CPR0) levels, C-peptide levels 6 min after glucagon stimulation (CPR6), the C-peptide index (CPI; CPR0 × 100/fasting plasma glucose) and stimulated C-peptide index (S-CPI; CPR6 × 100/plasma glucose 6 min after glucagon stimulation). U-CPR did not differ between liraglutide-effective and liraglutide-ineffective cases. Using receiver operating characteristic analysis adjusted for baseline characteristics, the independent cut-off value for effective liraglutide introduction was 0.72 for CPI and 1.92 for S-CPI. Conclusions: Evaluation of β-cell function using the glucagon stimulation test is useful for determining the efficacy of liraglutide introduction in patients with type 2 diabetes. © 2013 Asian Association for the Study of Diabetes and Wiley Publishing Asia Pty Ltd. Source

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